Nudges to Improve Patient Experience

In the National Adult Inpatient Experience Survey, two questions pertaining to patients' understanding of their medication side effects and condition management received low scores. This suggests that patients being discharged from the hospital don’t always understand the treatment they receive and how to manage their condition at home. Our Chief Behavioural Scientist worked with the Health Quality and Safety Commission and three partnering District Health Boards to investigate these low scoring questions and co-designed three nudges to improve patient experience in hospitals.

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Approach to Behaviour Change.

• Primary research – Conducted mixed methods research with hospitals across four District Health Boards (DHBs) which involved reviewing key documents, in-situ observations and interviews/focus groups with staff  members.

• Secondary data analysis – Analysed survey data to evaluate demographic differences and wider trends across similar questions

• Intervention design – Used the MINDSPACE framework to conceptualise nudges for changing behaviours.

• Co-designing and selecting our interventions - Developed interventions with consumers, pharmacy leads,nurse managers, clinical specialists and quality improvements  to ensure nudges were patient-centric, feasible and practical for hospitals.

• Nudge Selection – Identified suitable nudges for each of the three partnering hospitals.

• Behavioural Modelling – Synthesised key insights using the COM-B behaviour change model.

• Qualitative Assessment – Evaluated the impact of the three nudges via phone surveys with patients receiving each intervention.

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The Three Nudges.

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1. Home Safe Checklist: Patients were encouraged to prompt discussion about their medication, condition management and care plan.

Make it SOCIAL: Encourage patients to ask questions as the new norm

Make it EASY: Hospital staff can easily share relevant information

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2. Follow-up Call: Patients received a follow-up call from a hospital staff member to explain their medication side-effects

Make it TIMELY: Patients can absorb information in a relatively healthy state

Make it SOCIAL: Patients receive relevant information via a friendly,personalised follow-up call

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3. Optimised Discharge Summary: Patients checked their own knowledge gaps on a ‘behaviourally optimised’ discharge summary.

MAKE IT EASY: Make information cognitively easier to process

MAKE IT ATTRACTIVE: Draw attention to the right information

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Measurements.

For each of the three hospitals, a phone survey was conducted by a local pharmacist with 20 patients. We used the EAST framework to evaluate the impact of the interventions across the four parameters:

1. Easy – Did the nudge make it easy to get information?
2. Attractive – Was the format useful for you?
3. Social – Would you recommend the nudge for others?
4. Timely – Was the timing of the intervention useful for you?

The ‘Home Safe Checklist’ was pre-piloted at a hospital ward in Waikato DHB, the ‘Follow-up call’ was put on hold at Blenheim Hospital in Nelson-Marlborough DHB since the call durations were longer than anticipated and the ‘Optimised Discharge Summary’ is now ready for testing at Northland DHB following IT changes.

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Positive Outcomes.

Make it EASY – 9 out of 12 positive responses from the phone survey.‍

“Made it easy to ask, helped me decide what to ask”

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Make it ATTRACTIVE – 8 out of 10 positive responses from the phone survey.

“It covered everything I had doubts about”

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Make it SOCIAL – 10 out of 11 positive responses from the phone survey.

“For some people who have never been in hospital it would be good”

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Make it TIMELY – 9 out of 11 positive responses from phone survey

“Useful the day after you come into the ward”

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Overall the ‘Home Safe Checklist’ nudge excelled in the qualitative evaluation across all four measurement parameters. We have recommended a large scale pilot to rigorously measure the impact this has on improving patient experience in hospitals.

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Read the full report

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Vishal George is the Chief Behavioural Scientist at Behavioural by Design and hosts the Wellington and Auckland Behavioural Economics Network.