How can behavioural insights be applied in improvement work?

It is well known that when we do a repetitive task, such as brushing our teeth, we tend to lose awareness of the act. This is because it’s something that most of us do every day on autopilot.

What this means is that when we brush our teeth, we tend not to notice details like how much water or toothpaste we actually use, and often this can lead to inefficiency and waste. The example of brushing our teeth shows us that very often we do not behave in a way that we would expect to if we were perfectly rational human beings.

So, what can we learn from this to help inform our QI work, especially in light of pressures facing the NHS?

‘Behavioural insights’ has been described as the ​‘application of behavioural science to policy and practice with a focus on (but not exclusively) ​“automatic” processes’. Our behaviours are strongly influenced by factors that are outside of our conscious awareness.

We tend to underestimate the power of this ​‘automatic’ side of our behaviours. Behavioural insights, or ​‘nudges’ as they are often known, combine lessons from behavioural economics, psychology and neuroscience to better understand how humans behave and make everyday decisions.

Nudges are interventions that steer people in certain directions while maintaining their freedom of choice, recognising that many decisions – and ensuing behaviours – are automatic and not made consciously.

The Health Foundation has supported projects to design, test and evaluate behavioural interventions that can be applied to quality improvement.

We were interested in whether, for example, behaviour insight could be applied to improve efficiency and reduce waste across the health care system.

Two of these projects – medicine optimisation and procurement – are showing promising potential for nudge-type interventions that require relatively modest investment but can lead to system wide, scalable benefits including improved efficiency and better patient care.

One study, led by the University of Warwick, focused on medicine optimisation which is about getting the right patient the right choice of medicine at the right time.

Sub-optimal prescribing is costly to the NHS and affects patient wellbeing. This study explored ways of developing a collaborative approach to ensure medications are used safely.

Information gathered from this work will help to understand prescribers’ experiences with the interventions and – we hope – inspire other organisations to take up the approach.

In our study exploring how behavioural insights can be applied to online procurement, we looked at ways to generate cost savings without compromising quality. Of the £9 billion spent on procurement each year in the NHS, it is estimated that £1 billion could be saved by adopting best practices and modern systems.

This project focused on using a range of design features and prompts to encourage users to buy best value products and choose the most efficient delivery systems.

What our research has shown is that there is much more we can do to improve health and care through behavioural science. With guidance, and a relatively modest investment, it is possible to launch a health plan nudge unit to produce rapid results that can be replicated at scale.

Professor Ivo Vlaev, who is part of the University of Warwick’s Behaviour Science Group, shares more about the types of nudges which can support quality improvement. These include insights on where nudges did not work – such as with hand hygiene.