Nudging patients

Last week I was working with the Accidents and Emergency dept of a busy London hospital. One of the improvements we were discussing was a ticketing system so patients had some sense of being in a queue, not being forgotten, making progress towards being seen and helped.

There were some legitimate concerns from the hospital staff.  What about emergencies? What about re-prioritisation? What about different cases requiring different responses?

This morning I’ve been at the surprisingly smart and customer friendly UK passport office in London. I wish I could bring the management team of the hospital to see it.  Check in took moments as my personal details had already been taken (over the phone but could also be online or in a kiosk). I got my ticket P0456 and was told to wait in the lounge. Yes really, the lounge.

Clear screens around the lounge displayed three kinds of lists the P numbers, the F numbers and the A numbers.  As they scrolled through each I could see how far down my  queue I was. If they called an F or A number I assumed they had good reason.
There was also a list of counters and who they were currently serving so I was further reassured that work was being done and my turn would come soon.

A group of numbers at the top of each list were highlighted reminding these people to be ready to go. So if the queue had been longer I’d have known when it was safe to go to the loo or buy a drink from the vending machine.

When it came to my turn my number came on the screen along with the counter number I should go to. This was backed up by a computer generated announcement so even if I hadn’t been paying attention to the screen I probably would have heard the announcement.

An excellent example of a smooth running, informative, fair system that would also work for non-English speakers. Easy to transfer to emergency rooms around the country.

Behaviour research example: Nudging A&E patients

Challenge: Understand reasons for patients coming to A&E insted of using their GP and ways to affect that behaviour
Our approach:
visit A&E waiting room, interview patients and staff, observe behaviour

A few of our recommendations to encourage better choices for medical attention

  • There are two main patient types: the health manager and the health victim. It is

    Patient behaviour: health victim and health manager

    the latter group who are heavy users of A&E for a range of practical and emotional reasons, many of which can be addressed.

  • Nudging techniques are recommended to shift behaviour in a more patient-centric way eg raising awareness of the salient “cost” of their choice
  • Encourage patient empowerment / co-ownership. “It’s not only doctors or the Chief Executive who have responsibility for this hospital. We all must look after our society. This is a public service and we are all part of the public”

Timescale: 1 month
Full report: find it here: A&E patient behaviour