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What is the challenge or opportunity you are focusing on?

 CLCH is a large Community Trust across 10 London boroughs and Hertfordshire with over 3500 staff and 460 separate sites. CLCH has performed consistently below expected NHS average for the uptake of seasonal flu immunisation amongst health care workers for the past 5 years. Having tried every suggestion from NHS England, NHS Employers, global best practice and any other good ideas, we have made little impact on uptake figures. Feedback from staff reveals multiple reasons why the immunisation is not for them. E.g. ‘It doesn’t work’, ‘I am vegan’, ‘Religious reasons’, ‘I do not need it’. The challenge of dispersed geography, varied beliefs about the effectiveness and impact of flu vaccination and the autonomous nature of community based healthcare has led the Trust to consider the use of nudge theory to improve the uptake of the seasonal uptake of  flu vaccination.

Your proposal

We are curious to see if the application of nudge theory can impact on a ‘wicked’ organisational problem.

Using the nudge framework from the Health Foundation paper ‘Behavioural Insights in Healthcare’ 2015 we have tried to apply the concepts of nudge theory to our flu campaign for 2018/19. Using the analysis of how nudge can be applied effectively in healthcare, we have identified a suite of  ideas which we believe may ‘nudge’ people towards a more positive and preventative behaviour.

We are asking for funding to support the design and development of materials to make this a reality.

What is the benefit you hope to achieve?

Apart from the obvious benefit of protecting our staff, our patients and their families from seasonal flu, we hope to provide evidence and a case study for the effectiveness of applying behavioural insights and nudge information design principles  to wicked organisational problems.

What benefits do you expect for the Q community

We are happy to share our experiences, evidence and case study with Q members which would include:
•How we socialised the use of a psychological theory against an operational problem through Trust hierarchy
•Access to any supporting materials produced (i.e. video clips, poster designs, etc…)

How you can contribute

  • We would welcome other’s experience of using nudge theory on wicked operational problems and any other good ideas for increasing flu uptake! Especially ideas other than traditional incentivising/coercive techniques.


  1. Good idea and clearly important. We also used informal nudge ways of addressing flu vaccination this year with some success, (one of the best improvers in flu uptake) but still a way to go. I think we missed a trick with our patients through and am keen to get them involved more next year. I’m not clear form your proposal what the peer element will be and would be keen or hear more.

  2. Hi - got interested in "nudge" techniques during an infection prevention and control project in my days as matron at Leeds Teaching Hospitals, using nudge to get people to wash their hands - don't be the pass on infection.... seemed to be the one that worked. This was identified after lots of social market research. Let us know how you get on with the nudges that work - or send us spoilers for what you have found out already. Yorkshire Ambulance Service, where I work, had the most improved flu uptake last year, but are keen to do even more this year. Are you interested in trading secrets?

  3. Hi Team,

    A similar study is currently underway by Public Health England, you may want to get in touch with Tim Chadborn, who is leading the study.

    Dr Tim R Chadborn

    Behavioural Insights Lead Researcher


    I think further and additional studies in this area are really of value, so I'd be more than happy to support the approach at this stage.

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