“Nudge” and the epidemic of missed appointments

Abstract

Purpose - Missed appointments constitute a significant problem in the UK National Health Service (NHS) and this remains an area where improvements could yield substantial efficiency savings. The purpose of this paper is to suggest that nudge policies based on behavioural theories may help target interventions to improve patient motivation to attend appointments. Design/methodology/approach - The authors propose two policies to reduce missed appointments. The first attempts to empower patients through making the appointment system more individualised to them and utilising their intrinsic feelings of social responsibility. The second policy utilises a financial commitment given by the patient at the time of booking. The different mechanisms of influencing patient behaviour are based on two different views of what motivates individuals' actions. The first policy is based on individuals being "knights". They are altruistic and have well-intentioned values. The second policy option is constructed on the premise that an individual is governed by self-interest, and they are in fact "knaves". Findings - A policy, which avoids the use of financial penalties is likely to be more culturally acceptable within the NHS. It could also prevent the phenomenon of "crowding out" whereby the desire to act dutifully gets displaced by the motivation to avoid incurring a monetary fine. Originality/value - Testing both strategies would provide insight into patient attitudes towards health care and society. This would help optimise behavioural strategies which may influence not only appointment attendances but also have wider implications for encouraging rational health care consumption.

A telephone assessment and advice service within an ED Physiotherapy clinic: A single-site quality improvement cohort study

“…While no studies to date have assessed the impact of telehealth on wait times within an ED Physiotherapy clinic, these ndings are consistent with research conducted within other physiotherapy settings [12,35], along with other healthcare settings and patient populations [36][37][38][39]. No signi cant reduction in the non-attendance rate was observed for this telehealth care pathway, although it is worth noting that the 10% non-attendance rate observed in the telephone assessment and advice group compares well with regards to national [40] and international gures [41,42]. This nding is in sharp contrast to other literature [12,37,39,[43][44][45] and may be partly explained by the methodological study design and imbalance between study groups resulting in a high risk of confounding bias.…”

Decreasing the number of arthroscopies in knee osteoarthritis – a service evaluation of a de-implementation strategy

“…We experienced a large number of patients not completing the face-to-face portion of the programme. This is, unfortunately, all too common within the modern NHS [38,39]. We have implemented various strategies to mitigate this including giving patients a guide as the cost of the P-KIP [39].…”

“…This is, unfortunately, all too common within the modern NHS [38,39]. We have implemented various strategies to mitigate this including giving patients a guide as the cost of the P-KIP [39]. It is possible this dropout rate leads to skewing of our patient outcome data, but not the arthroscopy data.…”

Does pain take holidays? Non-attendance rates at a hospital-based pain clinic are elevated during the Jewish high-holidays

“…The healthcare system and the patient have a shared interest in patients keeping their appointments, and thus behavior modification (“nudge”) methods, based on theories from the realm of behavioral sciences may be the key to reducing rates of non-attendance [30]. There is consistent evidence that reminder systems improve appointment attendance rates across a range of health care settings and patient population sub-groups [31, 32].…”