behavioural insights in action forum
TRANSCRIPT
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Behavioural Insights in Action ForumTuesday 13 August 2013
Presented by the Institute for Public Administration Australia (IPAA) and the NSW Department of Premier and Cabinet
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Welcome
Peter AchterstraatPresident, IPAA NSWNSW Auditor General
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Welcome
Professor Mary O’KaneNSW Chief Scientist and Engineer
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FacilitatorStephen BradyDeputy Director GeneralStrategic Initiatives and PerformanceNSW Department of Premier and Cabinet
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http://policytoolkit.nsw.gov.au/bi
Visit our Behavioural Insights Community of Practice website:
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Keynote Speaker
Professor Peter JohnProfessor of Political Science and Public Policy at University College, London
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Behavioural Insights: an International setting
Peter John
University College London
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How interventions can find out how to get citizens to act pro-
socially
• Citizens are not passive - often interested in civic action and doing more for society
• But often they find it hard to translate interest and intentions into reality
• The behavioural economics take on this is that they tend to use short-cuts and go for easy options that can involve doing nothing -equivalent to leaving the letter on the mantelpiece
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Influencing citizen behaviour
• A line of experimental work shows that light-touch contacts with citizens can stimulate them to carry out more civic acts
• Door knocks, requests (‘asks’), leaflets, telephone calls have effects on turnout (see Green and Gerber 2008), recycling (Cotterill et al 2009) – effect sizes of 4-7 per cent
• Content of the message does not matter • More controversially – the mode does not matter (see John
and Brannan 2008, Fieldhouse et al 2011)• Citizens respond to the cue - they want to do these things,
but they need reminding - cuts into a behavioural economics take on civic action - people need shortcuts to do good
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Second generation experiments
• A new move to more targeted and manipulative experiments, using insights from social psychology
• Basic idea is that the citizen sees their actions in the light of what other citizens are doing
• Issue is that there are different ways of manipulating this information: a) social pressure b) recognition c) social information d) personalisation
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Mechanism: recognition
• Cotterill et al. (2010) test the whether the numbers of books citizens donate to charity depend on the manner in which they were asked.
• The research team randomly allocated 11,812 households in two electoral wards:
– a control group that were just asked to donate books to Africa
– a pledge group which were asked to pledge
– a pledge-plus-publicity group, which got the pledge but who were told that if they donated their names would be put up in a public place.
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Book Donations
Control Group Pledge Group Pledge & Publicity Group
Book donation 282 (7.2%) 320 (8.1%) 346 (8.8%)
No book donation 3665 (92.8%) 3617 (91.9%) 3592 (91.2%)
Total no. of households
3937 3937 3938
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The wider context of citizen-responsive services
• Highly centralised traditions of public management, systems designed by experts, then path dependence
• Consumerist trends – especially changes in the private sector, with large companies collecting micro information about consumers cf. Google
• More vocal dissatisfaction with services > citizen action, complaints
• Move to bring the citizen back in put at the heart of services
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The politics of nudge
• Not to do with fiscal austerity:– interest pre-dates current round, e.g. under New Labour– Obama employed Cass Sunstein, new White House Unit
• But more attractive in age of fiscal austerity -alternatives to money and laws (but note that laws and finance may be improved with behaviouraltechniques)
• Coalition government on its own with BehaviouralInsights team (set up for two years in July 2010, now extended)
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How academics and policy-makers work together
• Successful element of BIT - academics willing to help, flexible input
• Need to find the right academics!
• Work to their incentives:– interest in study design
– interest in being close to policy
– not too costly in terms of time
– good to get a publication outcome
– money is less important (but we do need some reward!)
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The limits to nudge
• How large are the effect sizes? How sustainable? (Depends on changing habits)
• How many defaults are there to change? • Diverts from traditional instruments: see
House of Lords Report, Behaviour Change• Natural life-cycle of new fads?• Depends on key people as supporters, e.g.
Head of Civil Service Gus O’Donnell (but successor just as enthusiastic)
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Limits to nudge (continued)
• Does it really challenge the economic model?
• Paternalistic? – see work of Bob Sugden
• Top down: how to reconcile with
decentralisation:
see Nudging Citizens
Towards Localism
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The ‘Think’ agenda
• Top down, manipulative
> needs a citizen directed
complement >
Think agenda
But think effects weak
Or long term?
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The impact of discussion versus information on organ donation
• The project compared the impact of information alone versus information and discussion on organ donor registration levels.
• 180 students were randomly assigned to three groups to receive one of the following interventions: a four page information booklet encouraging registration, the booklet followed by a 15 minute deliberation, information booklet about swine flu (placebo control)
• After the intervention, students were invited to join the organ donor register.
• Registration increased across all 3 groups • The information booklet had the greatest effect, and raised the
number of students on the organ donor register from 23 to 57 per cent, an increase of 17 per cent whereas nudge+think increased from 26 to 41 per cent (control from 34 to 64!).
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Conclusions
• Behavioural science offers a powerful set of insights for policy makers
• Part of citizen-orientated public management –making the citizen at the centre of decisions
• Does not get rid of incentives and the economic model: often behavioural insights and incentives work together
• How much evidence to change policies? Now moving beyond the quick wins. More RCTs
• Political support for nudge? Yes
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From the Beach to the Bed:Lessons for the recognition and
management of the deteriorating patient
Professor Cliff Hughes AOClinical Excellence Commission
13th August 2013
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Keynote Speaker
Professor Clifford HughesChief Executive of the Clinical Excellence Commission
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From the Beach to the Bed:Lessons for the recognition and
management of the deteriorating patient
Professor Cliff Hughes AOClinical Excellence Commission
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Safe Driving - NSW
(435)
376
? 1
? 2
Q 1 What happened here?Q 2 What caused this fall?CF Hughes: 26 September
2012
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IIMS enthusiasm
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CF Hughes AO1 August 2012 C F Hughes
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The Problem• Unrecognised deterioration is a
significant problem for patients* in all health systems despite ‘hallmark’ clinical signs of deterioration.
•
• *Vanessa Anderson (aged 16)24th October 2012 C F Hughes
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Aim: To improve early recognition and response to clinical deterioration and thereby reduce potentially preventable deaths and serious adverse events in patients who receive their care in NSW public hospitals.
Programme Aim
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Reliability of Observations
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April May June July C F Hughes
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Intervention on the Slippery Slope
PatientCondition
Time
ClinicalReview
ALS
Prevention
RapidResponse
The Solution
C F Hughes
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The Solution
• Identify missed opportunities to: • prevent• recognise• escalate• respond
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Standard Calling Criteria and Charts
• Simple to use- single trigger• Most sensitive indicator of deterioration first• Graphed vs. written observations• Clinical usefulness and relevance• Consolidation of observations for a ‘global’
view.• Ordered A-G to support patient assessment• National standards• ‘Photocopiable’ (including patient details)
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Adult Chart
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Human factors principles
• Reduce cognitive load and improve functionality– Top left hand corner is processed first– Font size and type– No overlap of parameters– Colour choice (emphasis)– Colour choice (colour blindness)– Consistency in formatting– Clear and descriptive labels– Low light legibility
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Setting Vital Sign Thresholds:
Getting the Balance Right• Patient Risk• Sensitivity• Specificity• Resource availability
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• Detecting Deterioration, Evaluation, Treatment, Escalation, and Communication in Teams
• Manual• E-learning modules• Clinical skills workshop
• Focus on improving the ability of clinicians to identify and respond to clinical deterioration at the ward level
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• Launched by the Minister for Health at Liverpool Hospital on the 13th January 2010.
• Observation Charts in use in all NSW Health Facilities
• All AHS/facilities have developed CERS procedures
• Rural AHS’s have collaborated with the Ambulance Service to develop models for provision of assistance (“CERS Assist”)
• All AHS’s progressing with Awareness Training and DETECT e-learning modules
Implementation
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• 4 KPI’s issued to LHD’s • 2 KPI’s have been included in
Performance Agreements (Rapid Response Call Rate and Cardio-respiratory Arrest Rate)
• Web-based system for collecting process data is being developed
Implementation (cont.)
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Governance
Standard Calling Criteria
(CERS)Clinical Emergency Response Systems
Education Evaluation
The 5 elements
Frontline CliniciansClinical Leads
Frontline CliniciansRapid Response TeamCERS Committees
Workforce ManagersEducatorsClinical Leads
Clinical Governance UnitsBTF ManagersCERS Committees
Observation Charts
Clinical Review/Rapid Response
Awareness, DETECT, Rapid Responders
2 KPIs & Evaluation Collaborative
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Stakeholder engagement and
consultation is vital
Clinicians• Coal face• Consult within
clinical context• Seek specialist
advice• Emergency• Maternity• Paediatrics
LHD• Executive
Sponsors• Programme
Managers• Equal
representation
DoH• Statewide
Services• CSQG• PSN• Family and
Community Partnerships
• NaMO
Child Health Networks NSW
Ambulance
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Progress to date• State-wide implementation of observation
charts (Adult and Paediatrics)• All facilities have a CERS procedure• Mothers at Risk Chart implemented 2012• EMR chart introduced into Emergency
Departments• Hospitals reporting decreased numbers of
cardiac arrests and preventable deaths• Broad clinician engagement
24th October 2012 C F Hughes
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State wide Results
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Lessons Learned• Executive and Clinical Leadership• A good plan• Branding and marketing• Partnership with Department of Health
and Local Health Districts• Governance structures• Awareness and Education
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Conclusions• Between the Flags has captured the
imagination of the staff of NSW• BTF is part of the language• Staff believe it is making a difference• Encouraging signs are there that it is
indeed reducing cardiac arrests• BTF must now become part of the
culture
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Conclusions• We need:
– The vision to see what must be done and what is possible
– A plan to make it happen– A coalition of the willing– The power of stories– The courage of leaders
WE HAVE THESE
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Small Group Discussion:NSW Case Studies
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FacilitatorStephen BradyDeputy Director GeneralStrategic Initiatives and PerformanceNSW Department of Premier and Cabinet
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http://policytoolkit.nsw.gov.au/topic/behavioural-insights-in-action
To continue the discussion, please visit our ‘Behavioural Insights in Action’ forum:
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Close
Peter AchterstraatPresident, IPAA NSWNSW Auditor General
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Behavioural Insights in Action Forum
Presented by the Institute for Public Administration Australia (IPAA) and the NSW Department of Premier and Cabinet