Behavioural Insights in Action Forum Tuesday 13 August 2013 - - PowerPoint PPT Presentation

Behavioural Insights in Action Forum

Tuesday 13 August 2013

Presented by the Institute for Public Administration Australia (IPAA) and the NSW Department of Premier and Cabinet

Welcome Peter Achterstraat

President, IPAA NSW NSW Auditor General

Welcome Professor Mary O’Kane

NSW Chief Scientist and Engineer

Facilitator Stephen Brady

Deputy Director General Strategic Initiatives and Performance NSW Department of Premier and Cabinet

http:/ / policytoolkit.nsw.gov.au/ bi

Visit our Behavioural Insights Community of Practice website:

Keynote Speaker Professor Peter John

Professor of Political Science and Public Policy at University College, London

Behavioural Insights: an International setting

Peter John University College London

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

• ptions that can involve doing nothing -

equivalent to leaving the letter on the mantelpiece

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
• M ore 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

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

M echanism: recognition

• Cotterill et al. (2010) test the whether the numbers
• f 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.

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

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

• M ore vocal dissatisfaction with services > citizen

action, complaints

• M ove to bring the citizen back in put at the heart
• f services

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 behavioural techniques)

• Coalition government on its own with Behavioural

Insights team (set up for two years in July 2010, now extended)

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!)

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)

Limits to nudge (continued)

• Does it really challenge the economic model?
• Paternalistic? – see work of Bob Sugden
• T
• p down: how to reconcile with

decentralisation: see Nudging Citizens Towards Localism

The ‘Think’ agenda

• T
• p down, manipulative

> needs a citizen directed complement > Think agenda But think effects weak Or long term?

The impact of discussion versus information on

• rgan 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
• ne 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!).

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. M ore RCTs

• Political support for nudge? Y

es

From the Beach to the Bed:

Lessons for the recognition and management of the deteriorating patient

Professor Cliff Hughes AO Clinical Excellence Commission

13th August 2013

Keynote Speaker Professor Clifford Hughes

Chief Executive of the Clinical Excellence Commission

From the Beach to the Bed:

Lessons for the recognition and management of the deteriorating patient

Professor Cliff Hughes AO Clinical Excellence Commission

Safe Driving - NSW

(435) 376

? 1 ? 2 Q 1 What happened here? Q 2 What caused this fall?

CF Hughes: 26 September 2012

IIM S enthusiasm

CF Hughes AO 1 August 2012 C F Hughes

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

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

Reliability of Observations

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Patient Label Date and Time Frequency of Observations Observations graphed, not written Pulse Rate Blood Pressure Respiratory Rate Temperature Pain Score Bowels O2 Saturations O2 - How? How much? Weight Observations outside normal range Completed

Physiological Parameter Docmented (%)

April May June July

C F Hughes

Intervention on the Slippery Slope

Patient Condition

Time Clinical Review ALS Prevention Rapid Response

The Solution

C F Hughes

The Solution

• Identify missed opportunities to:
• prevent
• recognise
• escalate
• respond

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)

Adult Chart

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

Setting Vital Sign Thresholds: Getting the Balance Right

• Patient Risk
• Sensitivity
• Specificity
• Resource availability

• 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

• 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

• 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.)

Governance Standard Calling Criteria

(CERS) Clinical Emergency Response Systems

Education Evaluation

The 5 elements

Frontline Clinicians Clinical Leads Frontline Clinicians Rapid Response Team CERS Committees Workforce Managers Educators Clinical Leads Clinical Governance Units BTF Managers CERS Committees

Observation Charts Clinical Review/Rapid Response Awareness, DETECT, Rapid Responders 2 KPIs & Evaluation Collaborative

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

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

State wide Results

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

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

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

Small Group Discussion: NSW Case Studies

Facilitator Stephen Brady

Deputy Director General Strategic Initiatives and Performance NSW Department of Premier and Cabinet

http:/ / policytoolkit.nsw.gov.au/ topic/ behavioural-insights-in-action

To continue the discussion, please visit our ‘Behavioural Insights in Action’ forum:

Close Peter Achterstraat

President, IPAA NSW NSW Auditor General

Behavioural Insights in Action Forum

Presented by the Institute for Public Administration Australia (IPAA) and the NSW Department of Premier and Cabinet