nhs wales: applying behavioural insights wa… · our responses to incentives are shaped by...
TRANSCRIPT
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NHS Wales: Applying behavioural insights
Luke Ravenscroft and Veerle Snijders
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Aims for the workshop
Answer 3 questions:
1. What are the main principles from behavioural science?
2. How can you apply these principles in practice?
3. How do we test whether the changes had an impact?
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Plan for the day
09.30 Aim and background10.00 Introduction to behavioural insights
- MINDSPACE- Group discussions
Lunch - 12.30 (will also have a coffee break)
13.30 Applying behavioural insights: - Organ donation and reducing missed appointments- Letter exercise: worked examples- Obesity
15.00 Break
15.15 Running a trial- TEST framework- Evaluation
16.30 Question and close
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About the team
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© Behavioural Insights ltdUNCLASSIFIED 5
“David Cameron’s Vanity Project”
There was a lot of skepticism
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Press coverage
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Academic Advisory Panel
Richard Thaler Chicago Booth
Business School
Nick Chater Warwick Business
School
Theresa MarteauUniversity of Cambridge
Gus O’DonnellFormer Cabinet
Secretary
Dan GoldsteinLondon Business
School
Maurice BiriottiSHM
Peter JohnUCL
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What are behavioural insights?
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Most policy concerns behaviour
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Addressing behavioural drivers is extremely important for improving health
Institute for Health Metrics and Evaluation (2013) The State of UK Health
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Traditional policy levers
Regulation
Incentives
Information
Behavioural Insights
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Criminal sanctions
Financial penalties
Communication
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We ran a trial on the ‘Tax Return Initiative’ with HM Revenue & Customs
Direct to form
Webpage
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Dr R Arnott2 Marsham StLondon SW1P 4DF
Robert,You really need to open this
Dr R Arnott2 Marsham StLondon SW1P 4DF
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Reanalysis of HMRC Trials:Self Assessment Tax
29% 33% 35%
19% 22%28%
Link to the campaign webpage in brown envelope
Direct to form in brownenvelope
Direct to form in whiteenvelope with hand written
message
Response Rate File rate
9%
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Lessons drawn from a variety of disciplines
Behavioural Insights
Psychology
Ethnography
Economics
Public Policy
Understanding how people behave in practice so that we can design policy better
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Behavioural insights in everyday life
We are not hyper-rational supercomputers with infinite time:• we rely on ‘automatic thinking’
• we have limited attention so use shortcuts
• we change our behaviour depending on the context
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Behavioural insights in everyday life
We are not hyper-rational supercomputers with infinite time:• we rely on ‘automatic thinking’
• we have limited attention so use shortcuts
• we change our behaviour depending on the context
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Automatic thinking: Two systems
SLOW•Effortful•Needs attention•Controllable •Analytic
FAST•Automatic•Little or no effort •No sense of control•Intuitive
System 1 System 2
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Automatic thinking: Two systems
SLOW• 17 x 13• Planning a trip abroad
FAST• 2 x 2• Taking your daily commute
System 1 System 2
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Automatic thinking: Two systems
A bat and ball cost a £1.10. The bat costs £1 more than the ball. How much does the ball cost?
A. 1pB. 10pC. 5p
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Automatic thinking: Two systems
A bat and ball cost a £1.10. The bat costs $1 more than the ball. How much does the ball cost?
We see £1.10 We see £0.10
System 1 is in control
BUT…..If ball costs £0.10, therefore bat must cost £1.10 – and £1.10 + £0.10 = $1.20
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Behavioural insights in everyday life
We are not hyper-rational supercomputers with infinite time:• we rely on ‘automatic thinking’
• we have limited attention so use shortcuts
• we change our behaviour depending on the context
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Mental short cuts; limited attention
We use shortcuts to make sense of the world
Upside: saves time and energy Downside: sometimes creates problems
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Mental short cuts; limited attention
We use shortcuts to make sense of the world
Shortcuts used by system 1
Upside: saves time and energy Downside: sometimes creates problems
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Danziger et al. 2010????
Mental short cuts; limited attention
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Behavioural insights in everyday life
We are not hyper-rational supercomputers with infinite time:• we rely on ‘automatic thinking’
• we have limited attention so use shortcuts
• we change our behaviour depending on the context
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Context matters
You go out to buy a belt. You find one for £12.
Someone tells you that can save £5 if you walk five minutes down the road to another shop. Do you walk five minutes to save the money?
A. YesB. No
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Context matters
You go out to buy a TV. You find one for £220.
Someone tells you that can save £5 if you walk five minutes down the road to another shop. Do you walk five minutes to save the money?
A. YesB. No
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Context matters
Hawton, et al. (2013) Long term effect of reduced pack sizes of paracetamol. British Medical Journal.
Changing packaging led to fewer deaths
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But do people just compensate elsewhere?
Kreitman (1976). The coal gas story. UK suicide rates, 1960-71. Journal of Preventative medicine.
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© Behavioural Insights ltdTait et al, 2014
Context matters
60%47%
36%
Glass cage Open dock Bar table
% found guilty• Gender of lawyer?• Race of the
defendant?• Time of day?
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MINDSPACE: a framework for applying behavioural insights
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What does MINDSPACE try to do?
• Using BI in policy
• Practical applications
• Memorable checklist (mnemonic)
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Messenger We are heavily influenced by who communicates information
IncentivesOur responses to incentives are shaped by predictable mental shortcuts such as strongly avoiding losses
Norms We are strongly influenced by what others do
Defaults We ‘go with the flow’ of pre-set options
Salience Our attention is drawn to what is novel and seems relevant to us
Priming Our acts are often influenced by sub-conscious cues
Affect Our emotional associations can powerfully shape our actions
Commitment We seek to be consistent with our promises, and reciprocate acts
Ego We act in ways that make us feel better about ourselves
MINDSPACE
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CabinetOfficeBehavioural Insights Team
Perceived authority(formal or informal)
Expertise, trust and liking
Peer effects, someone like me
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Can we get bank employees to give away one days pay?
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Proportion giving away a day’s salary to charity
5% 7%11% 12%
17%
Control Group Celebrity Sweets Personal email Sweets +Personal
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Our trial raised £500,000 in one day.
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Increasing payroll giving inside government
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The image of a colleague more than doubled the number of people who signed up
2.9%
6.4%
Control Group Image
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CabinetOfficeBehavioural Insights Team
Loss aversion
We discount the future
We overweight small probabilities e.g. lotteries
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Possibility of losing an 8% payment motivated teachers more than gaining 8%
Fryer et al. (2012) Enhancing the effectiveness of teacher incentives through loss aversion: A field experiment. NBER Working Paper no. 18237.
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We ran a lottery for voter registration
YOU AND YOUR HOUSEHOLD COULD WIN £5,000 IF THIS FORM IS RETURNED BEFORE 28 SEPTEMBER 2012
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The lottery was highly cost-effective (and the size of the prize didn’t matter much)
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© Behavioural Insights ltdFogarty A.W., Sturrock N., Premji K., Prinsloo P. (2013). Hospital clinicians’ responsiveness to assay cost feedback: a prospective blinded controlled intervention study. JAMA Internal Medicine,173(17).
Total number of tests ordered reduced by 32% post implementation
If scaled this could lead to £3m cash savings to the NHS per year
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Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation, Halpern et al. (2015)
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Discussion
● Discussion on your tables for 5-10 minutes
● One example of where you have seen these used in practice or could see these used in the future
○ Messenger effects
○ Incentives (non-financial or non-standard)
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CabinetOfficeBehavioural Insights TeamIf most people do the
right thing, let people know
Personalise the norm
Beware of boomerangs
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Nine out of ten people pay their tax on time.
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• With HMRC, our tax trials brought forward £200million in 12 months.
Nine out of ten people pay their tax on time.
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Social norms to increase tax payment rates within 23 days
33.6% 35.1% 35.9% 37.2% 39.0%
Control (8,558) UK Norm(8,300)
Local Norm(8,403)
Debt Norm(8,779)
Local + DebtNorm (8,643)
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“Por favor presente su declaración del impuesto sobre la renta”
“Si usted no declara, puede ser auditado y ser sujeto al procedimiento establecido por ley.”
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Standard letter – interestingly, it did not tell you how to file your taxes!
“Please file your declaration of income tax.”“If you do not declare, you may be audited and could face the procedure established by law.”
“According to our records, 64.5% of Guatemalans declared their income tax for the year 2013 on time. You are part of the minority of Guatemalans who are yet to declare for this tax”
“Previously we have considered your failure to declare an oversight. However, if you don’t declare now we will consider it an active choice and you may therefore be audited and could face the procedure established by law.”
“You are a Guatemalan citizen and Guatemala needs you. Be a good citizen and submit the 2013 annual return of Income Tax. […] Are you going to support your country?”
Control
BIT
Norms
Incentives
Affect / Ego
“According to our records, 64.5% of Guatemalans declared their income tax for the year 2013 on time. You are part of the minority of Guatemalans who are yet to declare for this tax”
“Previously we have considered your failure to declare an oversight. However, if you don’t declare now we will consider it an active choice and you may therefore be audited and could face the procedure established by law.”
“You are a Guatemalan citizen and Guatemala needs you. Be a good citizen and submit the 2013 annual return of Income Tax. […] Are you going to support your country?”
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BIT and the World Bank: Tax Compliance in Latin America
12.6%
18.4%20.3% 20.0%
22.7%21.1%
11.4%
17.3% 18.3% 18.3% 18.9%16.5%
Control(no letter)
GuatemalanTax
AuthorityLetter
BehaviouralLetter
BehaviouralLetter +National
Pride
BehaviouralLetter +
DeliberateChoice
BehaviouralLetter +SocialNorms
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CabinetOfficeBehavioural Insights Team
People take the easiest option
Even important decisions are
procrastinated
Prompted choice
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Changing the pensions default has meant 400,000 more people now have a pension
61%
83%
Opt-in Opt-out
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Changing the default application form helped disadvantaged children go to university
Source: Bettinger et al, 2011
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Discussion
● Discussion on your table for 5-10 minutes
● Again, any examples of where you have seen these used in practice or could see these used in the future
○ Norming
○ Defaults
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CabinetOfficeBehavioural Insights Team
We learn to block out the irrelevant
Keep things simple
Personalisation
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Dr R Arnott2 Marsham StLondon SW1P 4DF
Robert,You really need to open this
Dr R Arnott2 Marsham StLondon SW1P 4DF
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Eyewitness testimony
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Eyewitness testimony
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Eyewitness testimony
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Can you see a suspect?
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False Identifications without suspect in line-up
27%
9%
Simultaneous + Warning + Suspect Sequential + Warning + Suspect
(Steblay et al., 2001)
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Imperial College worked to simplify hospital prescription charts
King et al. (2014) Redesigning the ‘choice architecture’ of hospital prescription charts.BMJ Open.
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The revised chart reduced prescribing errors
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CabinetOfficeBehavioural Insights Team
Priming can take all sorted of forms
Words, sights & smells influence our behaviour
Size of plates and portion size effects how much we eat
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Priming honesty
$97 difference in insurance premiums
Miles declared
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Anchoring effects
Low anchor: “Do you think that the sentence will be
higher or lower than 1 year?”
High anchor: “Do you think that the sentence will be
higher or lower than 3 years?”
Source: Playing Dice With Criminal Sentences: The Influence of Irrelevant Anchors on Experts’ Judicial Decision Making
High anchor: 8 months extra prison time
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‘Bad’ behaviours can prime others
32%
69%
No Graffiti Graffiti
Littering Encouraged by Graffiti
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Discussion
● Discussion on your table for 5-10 minutes
● Again, any examples of where you have seen these used in practice or could see these used in the future
○ Salience
○ Priming
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CabinetOfficeBehavioural Insights Team
Emotional responses are fast and automatic
Moods can be more important than
deliberation
“Hot” and “cold” states
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Letters to persistent non-payers of road tax
UNTAXED VEHICLE WARNING
Our latest information shows you have not taxed your vehicle.
PAY YOUR TAX OR LOSE YOUR [MAKE OF CAR]
You have been caught driving your [make of car] untaxed.
Image captured on traffic camera of untaxed car stapled on the front of the letter
Original New New + image
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% Relicensing rates of persistent offenders to DVLA letters
40.4% 42.4%48.8%
Original New New + image
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Increasing legacy giving
5.0%
10.4%
15.4%
Control Just Ask Passion Ask
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CabinetOfficeBehavioural Insights Team
Commitment devices –make public and write down
People can actively choose to constrain their
future self
Importance of reciprocity
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(Scott Barbour/Getty Images)
All primary schools in Dumfries and Galloway have implemented a pre-ordering system.
Pre-ordering in schools
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Pre-ordering in schools
29.4
15.3
Pre-ordering No pre-ordering
Percentage of students who choose healthy lunch
Hanks, Andrew S., David R. Just, and Brian Wansink. "Preordering school lunch encourages better food choices by children." JAMA pediatrics 167, no. 7 (2013): 673-674.http://archpedi.jamanetwork.com/article.aspx?articleid=1682338
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Commitments can help us achieve goals
Williams, Bezner, Chesbro, Leavitt (2005)
0
10
20
30
40
50
60
70
80
90
Contract No Contract
% su
cces
s in
ach
ievi
ng e
xerc
ise g
oal
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CabinetOfficeBehavioural Insights Team
Attribution error – also applies to groups/teams
We overestimate our own abilities
We think of ourselves as consistent
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Our HM Revenue & Customs trial on Doctors and Dentists
1: The filing deadline for online tax returns is 31 January
If your tax return is not filed by this deadline you will have to pay a £100 late filing penalty
2: The purpose of this letter is to remind you about the Tax Health Plan campaign
Last year HMRC offered a voluntary disclosure opportunity to all GMC registered doctors.....
3: This is your final opportunity to contact us to ensure your tax affairs are up to date.
Your failure to contact us in the past may have been an oversight. However, if you do not respond to this letter, we will treat it as an active choice.
4: Same as 3, but includes this phrase at the top:
9 out of 10 people surveyed by Ipsos MORI in 2011 said that they trust their doctor to tell the truth.
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Doctors & Dentists’ response rate to different trial arms
4%21%
35% 35%
Generic Letter Traditional StyleMedics
Simplified (WeKnow + Oversight)
Simplified + IpsosMori data
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Appealing to professional identity to increase hand washing
Grant and Hofmann (2011) It’s Not All About Me: Motivating Hand Hygiene Among Health Care Professionals by Focusing on Patients.Psychological Science, 22 (12), 1494-1499.
37
54
"Handwashing prevents you fromcatching diseases"
"Handwashing prevents patients fromcatching diseases"
% h
and
was
hing
com
plia
nce
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Discussion
● Discussion on your table for 5-10 minutes
● Again, any examples of where you have seen these used in practice or could see these used in the future
○ Affect
○ Commitment
○ Ego
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Messenger We are heavily influenced by who communicates information
IncentivesOur responses to incentives are shaped by predictable mental shortcuts such as strongly avoiding losses
Norms We are strongly influenced by what others do
Defaults We ‘go with the flow’ of pre-set options
Salience Our attention is drawn to what is novel and seems relevant to us
Priming Our acts are often influenced by sub-conscious cues
Affect Our emotional associations can powerfully shape our actions
CommitmentWe seek to be consistent with our public promises, and reciprocate acts
Ego We act in ways that make us feel better about ourselves
MINDSPACE
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Lunch
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Plan for the day
09.30 Aim and background10.00 Introduction to behavioural insights
- MINDSPACE- Group discussions
Lunch - 12.30 (will also have a coffee break)
13.30 Applying behavioural insights: - Organ donation and reducing missed appointments- Letter exercise: worked examples- Obesity
15.00 Break
15.15 Running a trial- TEST framework- Evaluation
16.30 Question and close
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Applying behavioural insights in practice
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Behavioural insights adds another dimension
Behavioural Insights
1. Regulation
1. Incentives
1. Information
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Not just ‘nudges’....two different ways of applying behavioural insights
High-level policy(goals, rules, structures, funding, “terms of the debate”)
Opportunistic delivery(timing, wording, design, friction costs, trial and error)
Incr
emen
tal
chan
ge“S
tep
chan
ge”
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Organ donation
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Increasing organ donation registrations
Source: NHSBT
&
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Not just ‘nudges’....two different ways of applying behavioural insights
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What levers can you use to encourage organ donation?
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Not just ‘nudges’....two different ways of applying behavioural insights
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1. Three die every day… 2. You can save nine lives…
3. If you needed transplant… 4. If you support donation…
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Proportion joining the organ donor register after a simple online prompt
2.3%3.1% 2.9% 3.2%
2.8%
Control 1. Three die 2. You cansave
3. If youneeded
4. If yousupport
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Our organ donation trial added 100,000 organ donor registrations in a year.
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Smoking in pregnancy: we don’t always know what will work
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Reducing missed hospital outpatient appointments
Trial partners
Michael Hallsworth, Dan Berry, Michael Sanders, Anna Sallis, Dominic King, Ivo Vlaev, AraDarzi (2014) Stating appointment costs in SMS reminders reduces missed hospitalappointments: Findings from two randomised controlled trials. Under review at PLOS One
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Trial 1 Messages
Name Message
ControlAppt at [hospital] on [Sep 16] at [10:00am]. To cancel or rearrange call the number on your appointment letter.
Number Appt at [hospital] on [Sep 16] at [10:00am]. To cancel or rearrange call 02077673200.
Norm We are expecting you at [hospital] on [Sep 16] at [10:00am]. 9 out of 10 people attend. Please call 02077673200 if you need to cancel or rearrange.
Costs We are expecting you at [hospital] on [Sep 16] at [10:00am]. Not attending costs NHS £160 approx. Call 02077673200 if you need to cancel or rearrange.
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The best performing message reduced missed appointments by 25%
11.1%9.8% 10.0%
8.5%
Control Number Norms Costs
Total n = 10,111 * p < 0.05, ** p < 0.01
**
% of appointments recorded as missed
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•This result would lead to 5,800 fewer missed appointments if applied over one year in same location
406,740 fewer if applied in England
Benefits x5 with full mobile coverage
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Trial 2 Messages: Best-performing message now the default
Name Message
Costs specific
We are expecting you at [hospital] on [Sep 16] at [10:00am]. Not attending costs NHS £160 approx. Call 02077673200 if you need to cancel or rearrange.
Costs general
We are expecting you at [hospital] on [Sep 16] at [10:00am]. Not attending wastes NHS money. Call 02077673200 if you need to cancel or rearrange.
FairnessWe are expecting you at [hospital] on [Sep 16] at [10:00am]. Please be fair to others waiting and call 02077673200 if you need to cancel or rearrange.
Recording We are expecting you at [hospital] on [date] at [time]. Please attend or call 02077673200 to cancel/rearrange, or we will record as a missed appt.
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Specific costs work better than general costs
11.7% 10.6% 9.6% 9.8% 8.2%
Control (fromprevious trial)
Fairness Recording General costs Specific costs
% of appointments recorded as missed
Specific costs (“£160”) are more effective
Total n = 9,862 * p < 0.05, ** p < 0.01
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Finally… reciprocity matters: if hospital cancels on you, you are more likely to not attend later
65.7% 72.5%
Last Session Cancelled Last Session Not Cancelled
Atte
ndan
ce
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Letter exercise
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Applying behavioural insights in practice
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Behavioural insights adds another dimension
Behavioural Insights
• Regulation
• Incentives
• Information
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Not just ‘nudges’....two different ways of applying behavioural insights
High-level policy(goals, rules, structures, funding, “terms of the debate”)
Opportunistic delivery(timing, wording, design, friction costs, trial and error)
Incr
emen
tal
chan
ge“S
tep
chan
ge”
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High-level policy: Obesity
We need a new policy narrative for obesity.
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High-level policy: Obesity
• Consuming food is often a “mindless” response to our environment.
• The past thirty years have seen a massive increase in the supply of calories and our exposure to these calories.
• Physical activity brings a variety of health benefits. However, it is mainly an increase in calorie intake, not a decline in physical activity levels, that has caused the obesity problem. Increasing activity alone is unlikely to be the solution.
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High-level policy: Obesity
• Consuming food is often a “mindless” response to our environment.
• The past thirty years have seen a massive increase in the supply of calories and our exposure to these calories.
• Physical activity brings a variety of health benefits. However, it is mainly an increase in calorie intake, not a decline in physical activity levels, that has caused the obesity problem. Increasing activity alone is unlikely to be the solution.
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Mindless eating: Visibility and proximity of food
7.7
4.65.6
3.1
6.5
3.8
6.1
3.5
Close and Visible Close and not-visible
Far and visible Far and not visible
Actual Number of Sweets Consumed
Estimated Number of Sweets Consumed
Wansink, B., Painter, J. E., & Lee, Y. K. (2006). The office candy dish: proximity's influence on estimated and actual consumption. International Journal of Obesity, 30(5), 871-875.
Food that is closer and more visible to us is more likely to be eaten.
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Mindless eating: We underestimate the calories in a “healthy” meal
8701085 1170
779
Actual calories Perceived calories Actual calories Perceived calories
Adapted from Chandon, P. (2013). How package design and packaged-based marketing claims lead to overeating. Applied Economic Perspectives and Policy, 35(1), 7-31.
“Unhealthy” meal “Healthy” meal
+ 25% -33%
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High-level policy: Obesity
• Consuming food is often a “mindless” response to our environment.
• The past thirty years have seen a massive increase in the supply of calories and our exposure to these calories.
• Physical activity brings a variety of health benefits. However, it is mainly an increase in calorie intake, not a decline in physical activity levels, that has caused the obesity problem. Increasing activity alone is unlikely to be the solution.
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Portion sizes have increased greatly in the last 30 years.
Levitsky, D. A., & Pacanowski, C. R. (2011). Free will and the obesity epidemic. Public Health Nutrition, 15(1), 126
Calorie supply: Portion sizes
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Calorie supply: Portion sizes
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High-level policy: Obesity
• Consuming food is often a “mindless” response to our environment.
• The past thirty years have seen a massive increase in the supply of calories and our exposure to these calories.
• Physical activity brings a variety of health benefits. However, it is mainly an increase in calorie intake, not a decline in physical activity levels, that has caused the obesity problem. Increasing activity alone is unlikely to be the solution.
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Physical activity: Levels are not correlated with obesity for children
Source: PHE KIT Team – Public Health Outcomes Framework, ONS
Health Survey for England 2012
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Physical activity: Levels have remained relatively static over time
Talbot, L. A., Fleg, J. L., & Metter, E. J. (2003). Secular trends in leisure-time physical activity in men and women across four decades. Preventive medicine,37(1), 52-60.
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Physical activity: In contrast, energy intake appears to be correlated with obesity levels
Levitsky, D. A., & Pacanowski, C. R. (2011). Free will and the obesity epidemic. Public Health Nutrition, 15(1), 126
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The need for a new policy narrative
• People tend to think they have more control over their eating than they do.
• This leads to unsuccessful attempts to control eating based on willpower.
• People can take responsibility, but only if they understand the habitual, contextual, automatic nature of eating.
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Ideas to reduce obesity
1. Pre-ordering in schools
2. Labelling
3. Fast-food Exclusion Zones
4. SSB tax, Sugar tax
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1. Pre-ordering in schools: Theoretical basis
• People are more willing to commit to virtuous behaviour if it occurs in the future.1
• 74% of people who chose a healthy snack one week in advance swapped to an unhealthy one when given the choice.2
• People want to pre-commit: a recent study found that self-aware consumers will choose to commit to healthy choices.5
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1. Pre-ordering in schools: Existing studies
29.4
15.3
Pre-ordering No pre-ordering
Percentage of students who choose healthy lunch1
Hanks, Andrew S., David R. Just, and Brian Wansink. "Preordering school lunch encourages better food choices by children." JAMA pediatrics 167, no. 7 (2013): 673-674.http://archpedi.jamanetwork.com/article.aspx?articleid=1682338
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1. Pre-ordering in schools: Existing examples
OS9
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Slide 133
OS9 love it. one obvious question is why give kids the choice to have an unhealthy meal? why not just make all the food healthier? (presumably to encoruage people to actually go to the canteen?)Owain Service, 02/07/2014
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1. Pre-ordering in schools: Existing examples
(Scott Barbour/Getty Images)
All primary schools in Dumfries and Galloway have implemented a pre-ordering system.
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• There are theoretical reasons to be cautious about calorie labelling.
• There is some real-world evidence that it can reduce calorie consumption modestly.
• There are labelling alternatives that appear to be more effective than calorie labelling. The most attractive is traffic light labelling.
2. Labelling: Calorie labelling
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2. Labelling: Simplicity is key
VS.
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The Department of Health’s ‘Guide provides a simple table to determine the traffic light colours
The traffic light element will remain voluntary and exists in addition to the information mandated by the European Commission regulation.
2. Labelling: Single traffic lights: Implementation: Policy landscape
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Menus: Control
Menus for “Drinks” and “Sides & Desserts” were in the same format
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Menus: Numeric calorie labelling
Menus for “Drinks” and “Sides & Desserts” were in the same format
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Menus: 3 traffic lights (traditional system)
Menus for “Drinks” and “Sides & Desserts” were in the same format
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Menus: 3+ traffic lights (extended orange)
Menus for “Drinks” and “Sides & Desserts” were in the same format
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Menus: 4 traffic lights
Menus for “Drinks” and “Sides & Desserts” were in the same format
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The best traffic light system reduced total calories purchased by 12%
Reduced byabout 100 kcal
* Significantly different (p < 0.05) from control
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• Will power is a limited resource in the short term.
• Effect may be particularly noticeable after school when cognitive resources are drained from day of school2.
• Social norms can increase the likelihood that people indulge in unhealthy snacks1.
3. Fast-food Exclusion Zones: Behavioural rationale
(Scott Barbour/Getty Images)
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3. Fast-food Exclusion Zones: Secondary Schools and Hot Food Takeaways
Secondary Schhols and 400m buffers with A5 Food Outlet Catchment HotspotsTaken from Food Outlet Mapping in the London Borough of Newham (2010)
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• If we believe this is so important, why not introduce a tax?
• Pros• Viable close substitute• Drive reformulation• No nutritional benefit• Don’t notice the calories
• Cons• Too interventionist?• Regressive?• Real-world evidence?
4. Taxes: SSB or sugar tax
(Scott Barbour/Getty Images)
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Questions?