Q: What is meant by behavioural insights and how can it be used to improve health and care?
DP: I don’t need to tell you that human behaviour is complex, often irrational, and a lot more context-specific than classic economics may have suggested. But too often, and quite problematically, practice and policy is based around the belief that people analyse information and incentives and then act in predictable ways. Is it any wonder that our carefully crafted and thought-out ideas to improve care quality don’t always demonstrate the impact we hoped for? One way that we can begin to re-orientate our thinking as quality improvers, is to shift away from mindset of assuming people are rational economic actors to one where we recognise that context and thinking ‘errors’ – or cognitive biases – play a key role in driving decision-making and behaviour. And if we start here, this is where behavioural insights can play a role.
…it’s about attempting to change behaviours, without changing minds.
Behavioural insights combine lessons from behavioural economics, psychology and neuroscience. Very simply it is the study of what we do, why we do it and how to influence it. At the core of many behavioural insight lessons is the idea that human behaviour is often influenced by ‘automatic’ responses to our context or environment. One way of summarising what the application of behavioural insights is trying to achieve is to say it’s about attempting to change behaviours, without changing minds. And although academics and scientists have been studying the quirks of human behaviour and decision making for decades, it’s a relatively new and exciting area of applied science, especially in its potential application to common challenges we all face to improving health and health care in the UK.
So, for example, by applying behavioural insight thinking to how to frame a message you can have a significant impact on participation – all achieved simply by moving words around in a sentence. People are strongly influenced by what others do, who communicates messages, how information is presented – and we behave in ways that make our lives easier. All this sounds obvious, but knowing this and how it can be applied allows us to design and implement quality improvement initiatives that have a greater likelihood of realising what we set out to achieve.
Q: Do behavioural insight ‘nudges’ work even if you know they are happening to you?
DP: Good question, and to be honest I don’t know definitively one way or the other. I suppose that if you go into a situation where you know what and how behavioural insights are attempting to nudge, you can make an active decision not to ‘comply’ – but you would need to ask yourself why you are doing that?
A well-designed nudge seeks to play-out in a way that aligns with individual preferences…
A well-designed nudge seeks to play-out in a way that aligns with individual preferences, making it easier to enact behaviours that lead to the desirable outcomes individuals wish to realise, without restricting choice. One way this can be achieved is using defaults. So, for example, automatic enrollment onto workplace pensions in the UK has seen participation increase by over a third and significantly increased the average contribution rate, even though people have always been free to opt-out of or reduce pension contributions. And whilst this is only one important example, it does suggest that well-considered and meaningful nudges can work even if people are aware of them.
Q: Can anyone use behavioural insights?
DP: This is what we want to find out at our session at the UK-wide Q community event. We are finding many lessons emerging from the behavioural insights world that we think can be applied to quality improvement efforts. There are several concepts that if better understood and practically adopted, may lead to the more effective design and implemention of ideas that support lasting and improved care quality. And encouragingly, we are also seeing more and more people without formal training or education in behavioural insights successfully apply the thinking to long standing quality challenges.
Of course, behavioural insights are not a ‘silver bullet’, but should be viewed as another tool in the improver’s toolbox. And knowing which tool to pick and understanding how to use that tool – whilst being mindful of unintended consequences – will be critical for successfully deploying behavioural insight thinking in routine quality improvement. My gut feeling is that the fantastic quality improvement community possesses all the where-with-all to be able to take well-evidenced behavioural insight concepts and to adapt and run with them. Our challenge is to connect, support and learn from one another, and to spread and diffuse what we are learning.
Our challenge is to connect, support and learn from one another, and to spread and diffuse what we are learning.
Q: What should members do to prepare for the session and what can they expect to get out of it?
DP: Bring your curiosity, bring your creativity and be ready to share your ideas and reflections. Come prepared to meet like-minded people that are passionate about improving care quality and who also see a role for embedding behavioural insights into routine quality improvement efforts. At the end of the session we will be canvassing your thoughts on what support, resources and ideas you have to make behavioural insights a normal part of your day jobs.
And don’t be late to the session, we’ll kick-off with a fantastic, but very short, exercise that will bring some key learning from behavioural insights to life!
Q UK-wide annual event, Wednesday 19 September , Birmingham NEC
Behavioural Insights breakout session,13:30 – 14:40
There are a small number of spaces remaining for this session – sign up at registration on the morning of the event if you want to attend