Nudging in health: the UK experience 11 May 2015 Dan Berry UK Government Department of Health: behavioural insights team Email: daniel.berry@dh.gsi.gov.uk Twitter: dan_berry79
What I ll talk about 1. Why the UK government and National Health Service (NHS) is increasing applying behavioural insights 2. Examples from across health services and public health 3. A game 2 DH Leading the nation s health and care
About 1 in every 10 NHS outpatient appointment is missed This leads to poor patient care It wastes NHS resources: one estimate put this at 225 million Your challenge is to reduce missed hospital appointments by a quarter - without spending any money - without retraining staff or introducing complex system changes - without penalising patients 3
Percentage of appointments that are missed Appt at St Barts Hospital on Sep 26 at 2.30. To cancel or rearrange call the number on your appointment letter. Appt at St Barts Hospital on Sep 26 at 2.30. To cancel or rearrange call 02077673200. We are expecting you at St Barts Hospital on Sep 26 at 2.30. 9 out of 10 people attend. Call 02077673200 if you need to cancel or rearrange. We are expecting you at St Barts Hospital on Sep 26 at 2.30. Not attending costs NHS 160 approx. Call 02077673200 if you need to cancel or rearrange. Existing message Easy Call Social Norms Specific Costs 12 Effect of messages on missed appointments (N = 10,111) 10 8 6 11.1 9.8 10 8.4 4 2 0 Existing Message Easy call Social Norms Specific Costs Hallsworth M, Berry D, et al: Stating appointment costs in SMS reminders reduces missed hospital appointments. (2015: publication pending) 4 DH Leading the nation s health and care
Benefits of behavioural insights Understanding how people actually behave helps us design effective policy and implementation programmes. Behavioural insights can inform interventions that are: Cheap: often optimising existing processes or materials Scalable: do not require intensive training or system reorganisation Light touch: limited burden on those who wish to continue as they are 5 DH Leading the nation s health and care
Three examples of nudge interventions targeting patients or the public 6 DH Leading the nation s health and care
Attendance rate % 35 30 33 25 20 29 15 10 5 Old letter Commitment device letter 0 old letter nudge letter Bonus A, Berry D: Increasing Uptake of the NHS Health Check. Report of research with Medway Council to optimise the invitation letter. 2013. available at www.healthcheck.nhs.uk/document.php?o=588 7 DH Leading the nation s health and care
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Current NHS prescription form: state eligibility for free prescription before the honesty declaration New NHS prescription form: honesty declaration first, then state eligibility for free prescription 10 DH Leading the nation s health and care
Three examples of nudge interventions targeting clinicians 11 DH Leading the nation s health and care
Simple and timely feedback Fogarty AW, Sturrock N, Premji K, Prinsloo P. Hospital clinicians responsiveness to assay cost feedback: a prospective blinded controlled intervention study. JAMA Intern Med 2013;173:1654 5. 12 DH Leading the nation s health and care
Proportion of medication orders The revised chart led to much more accurate information (and less errors) 100.0% 90.0% Existing chart (n=174) Improved chart (n=163) 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Dose entered correctly Prescriber's contact number entered Frequency of medications entered correctly King et al. (2014) Redesigning the choice architecture of hospital prescription charts. Forthcoming. 13 DH Leading the nation s health and care
Test your knowledge 14 DH Leading the nation s health and care
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Cabinet Office and DH : Applying Behavioural Insights to Organ Donation: preliminary results from a randomised controlled trial http://www.behaviouralinsights.co.uk/publications/applying-behavioural-insights-organ-donation 24 DH Leading the nation s health and care
Recap of the benefits Behavioural insights can inform interventions that are: Cheap: often optimising existing processes or materials Scalable: do not require intensive training or system reorganisation Light touch: limited burden on those who wish to continue as they are Great framework: search for behavioural insights EAST Email Dan Berry: daniel.berry@dh.gsi.gov.uk 25 DH Leading the nation s health and care