I am currently reading ‘Nudge’ by Richard Thaler and Cass Sunstein [Nudge: improving decisions about health, wealth and happiness]. I am hoping to pick up some tips which will help the campaign succeed. Apparently one of the most effective ways to ‘nudge’ people (help them make decisions good or bad) is via social influence. One of the social influences they cite is peer pressure.
We learnt a while back when delivering ‘patient safety first’ that peer to peer influence was a key success factor in convincing clinicians to adopt a new practice. It relates to caring about what people think and especially the people around you or those that are like you – often because we want to be liked and we want to conform. As it says ‘humans are easily nudged by other humans’.
So how does this relate to change?
- Our experience is that peer to peer influence works for a large section of the population but not all. There are still those that resist, that do not want to conform. This has been clearly evident in the use of the surgical checklist or in washing hands.
- There is also a tendancy for groups to stick to established patterns or behaviours even when changes are desperately needed or even when the original pattern or behaviour is now redundant.
- People are more likely to conform when they know that other people will see what they are doing or see what they have to say. This speaks to the compliance culture in the NHS and particularly in the way that people behave differently when being assessed or inspected. As we all know – the classic description of a culture is ‘one that exists when no one is looking’.
- People also follow an existing practice because they think that most other people like it; all assuming everyone else must be happy because they have not said any different.
Thaler and Sunstein suggest that a small shock, or nudge, can dislodge these behaviours. For example a city trying to encourage people to exercise more, may simply produce the numbers of people already exercising, plus name a few influential people who are exercising. These two things (lots of other people exercising and influential people exercising) provides a strong signal that nudges others to exercise. Encouragement costs nothing.
Apparently if we want to shift behaviour we might be able to do this simply by informing people about what other people are doing!
Happily we have been doing this in the campaign already. Our approach is to inform people about safety improvement activities other people (similar to them) are doing; we have started to create beacon clinical commissioning groups to influence other CCGs to join; and we have been sharing the stories of those considered influential (opinion leaders and respected patient safety experts). We know that the NHS is one of busy people trying to cope in a complex world – we need to make it easier for them to make safer choices. Our aim is to influence improvements in safety but also to influence those who are working in safety to think differently about safety and ultimately create a sustained approach to safer care across the NHS.