Behavioural (*nudge*) insights – part 3

One of the sessions I attended was titled ‘You are the doctor’ this was a session on patient safety and I was more than intrigued to see what the behavioural insights world had to add to the work that we all do on patient safety.  Would I find any additional insights, would I find a new way of looking at patient safety?

The session was led by one of the behavioural insights team (BIT) Michael Hallsworth, and the speakers were;

  • Marjorie Stiegler @DrMStiegler (her twitter profile says she is a doctor from the US who also explores medical decisions, patient safety and error via human factors and cognitive psychology)
  • Dominic King @digitalstitched (his twitter profile says he is a clincal lecturer in surgery, behavioural economist and digital health enthusiast at Imperial College)
  • Peter Jaye an emergency department consultant who I quote “usually gets home at 1 in the morning from work” so I suspect is way too busy to be on twitter!

There was an introduction into patient safety which quoted the Health Foundation as the source for the 10% adverse event rate (which in itself I found fascinating that (a) is this what happens with original research that people tend to quote the last person who said it and (b) I didnt know why it bothered me so much).

The audience members were told that they would see a series of videos and that they would be ‘making the decisions’ – in reality I am not sure how much the audience decided but it was a neat way of trying to immerse an audience into the difficult world of medical decision making.  The context was accident and emergency, the viewpoint was from a junior doctor.  It was the video equivalent of simulation training without the added addrenaline increase and total embarrassment when you make the wrong decision in front of people who are ‘assessing’ (judging) you.

The conference programme said ‘you will see how making decisions can be a matter of life of death (yes we got that) and how we can ensure they are made better (unfortunately no we didnt get that).  There was some discussion about training, education, decision support systems, teamworking and the fact that in healthcare we are working with different team members every day, attitudes between doctors and nurses, use of titles (do you call your consultant by their first name or Doctor, Professor, etc) and hierarchy.

I was left wondering where this intervention could be applied in the NHS and if it was, what difference would it make? It probably would be useful to try it out on different audiences; e.g. show it to frontline clinicians – (a) one separated into doctors only and (b) one for the multidisiciplinary team – to test out whether it is a useful way of helping people understand the behaviour, culture, human factors and system factors that affect patient safety and whether you learn this better amonst your peers or amongst the representative ‘healthcare team’. To make it even better for me it should include an additional aspect of applying new knowledge into practice. The take away stuff people can actually put into practice tomorrow.

Having been to mainly patient safety type conferences over the last 20 years or so being at a ‘new’ topic conference opened my eyes to conferences in a way that I wouldn’t have got if I had attended yet another patient safety one. A specific blog on conferences will be coming soon.  In summary conferences provide you with a certain level of information, understanding and insight so that you can appreciate the subject but more importantly you do not gain enough knowledge so that you can apply that knowledge into practice.  It is a window into the subject matter but nothing more.  In other sessions I attended even those that described their own research in relative detail, I could still not quite understand how to put this information into practice. Perhaps I am missing the point.  Perhaps applied social psychology or behavioural economics is different for and unique for every area it tries to effect.  So there is nothing that is generalisable (apart from make it easy and get the evidence).  I shall let you know when I have read all the reports I referred to in Part 1!