This document outlines an agenda for a conference on applying behavioural insights to improve healthcare. The objectives are to help attendees understand the concept of "nudging" and how behavioural insights can be applied in clinical settings. Presentations will cover topics like understanding and changing behaviour using insights from psychology. Attendees will learn how to apply these insights to specify target behaviours, understand what influences behaviours using models like COM-B, and design interventions using techniques like simplifying messages and leveraging social influences. The goal is to encourage attendees to implement what they learn back in their own organizations.
Isn't this about me? The role of patients and the public in implementing evid...NEQOS
Master Class, led by Professor Richard Thomson- focusing on the role of patients and public in implementing evidence-based healthcare- including shared decision making
iWantGreatCare's 7th National Symposium - Building fantastic staff morale, improving quality and reducing costs - took place on Tuesday 21st June at The King's Fund, London.
NHS leaders share their experiences of how they are building excellence in their Trust, reducing costs and growing staff morale by listening to the voice of the patient.
View the slides from these well-regarded delegates:
Alwen Williams, Chief Exective, Barts Health NHS Trust
David Behan, Chief Executive, Care Quality Commission
Dr Nadeem Moghal, Medical Director, Barking, Havering and Redbridge University Hospitals NHS Trust
Liz Mouland, Chief Nurse, First Community Health and Care
Jeremy Howick, clinical epidemiologist and philosopher
The NHS Bermuda Triangle by Marc Baker, Ian Taylor and Daniel T JonesLean Enterprise Academy
We've been applying Lean Thinking in healthcare for the past five years, Over that time we have discovered two things:
First, the good news. Lean works in healthcare. The Bad news: Lean will never take toon in the NHS as it stands: it is management that needs to change.
Led by Dr Adi Cooper, this interactive webinar draws on local authorities' experience of leading effective safeguarding with the new requirements of the Care Act. We will invite questions from attendees in advance of the webinar, discuss common issues and queries with the input of colleagues from practice, and share information about what is working effectively in this area. We anticipate a focus on implementing a 'Making Safeguarding Personal' approach into practice.
Aimed at: Practitioners and managers involved in safeguarding adults
Engaging service users and healthcare staff in quality improvement: a practic...MS Trust
This presentation by Glenn Robert from the National Nursing Research Unit and King's College London looks at what experience based co-design is, and why do it.
It was presented at the MS Trust Annual Conference in November 2014.
Isn't this about me? The role of patients and the public in implementing evid...NEQOS
Master Class, led by Professor Richard Thomson- focusing on the role of patients and public in implementing evidence-based healthcare- including shared decision making
iWantGreatCare's 7th National Symposium - Building fantastic staff morale, improving quality and reducing costs - took place on Tuesday 21st June at The King's Fund, London.
NHS leaders share their experiences of how they are building excellence in their Trust, reducing costs and growing staff morale by listening to the voice of the patient.
View the slides from these well-regarded delegates:
Alwen Williams, Chief Exective, Barts Health NHS Trust
David Behan, Chief Executive, Care Quality Commission
Dr Nadeem Moghal, Medical Director, Barking, Havering and Redbridge University Hospitals NHS Trust
Liz Mouland, Chief Nurse, First Community Health and Care
Jeremy Howick, clinical epidemiologist and philosopher
The NHS Bermuda Triangle by Marc Baker, Ian Taylor and Daniel T JonesLean Enterprise Academy
We've been applying Lean Thinking in healthcare for the past five years, Over that time we have discovered two things:
First, the good news. Lean works in healthcare. The Bad news: Lean will never take toon in the NHS as it stands: it is management that needs to change.
Led by Dr Adi Cooper, this interactive webinar draws on local authorities' experience of leading effective safeguarding with the new requirements of the Care Act. We will invite questions from attendees in advance of the webinar, discuss common issues and queries with the input of colleagues from practice, and share information about what is working effectively in this area. We anticipate a focus on implementing a 'Making Safeguarding Personal' approach into practice.
Aimed at: Practitioners and managers involved in safeguarding adults
Engaging service users and healthcare staff in quality improvement: a practic...MS Trust
This presentation by Glenn Robert from the National Nursing Research Unit and King's College London looks at what experience based co-design is, and why do it.
It was presented at the MS Trust Annual Conference in November 2014.
Crowdsourced health predictions for 2016 (a free gift of wonder) curated by D...Gautam Gulati, MD,MBA,MPH
2nd ANNUAL EDITION
A crowdsourced flip book of the community’s wildest predictions for health in 2016.
We asked a simple question:
What do you believe will be the single biggest transformational change in health, wellness, or medicine in 2016?
The answers are in. Take a look inside.
This is our free 'gift of wonder' to all of those who inspire us everyday to do the unimaginable, and think the unusual.
Nick Filer - Digital technology transformation of outpatient servicesInnovation Agency
Presentation by Nick Filer, Health Innovation Manchester: How and why to incorporate the patient voice into your change programmes, Digital technology transformation of outpatient services, 2 July 2018, Haydock Park Racecourse
Barry's standard handouts providing a narrative description of what he presents. Includes a discussion of the common factors and the Partners for Change Outcome Management System
How to make care and support planning a two-way dynamic - presentation from webinar held on 1 October 2014
This relates to the first NHS IQ Long Term Conditions Improvement Programmes Wednesday Lunch & Learn Webinar Series. How to make care and support planning a 2 way dynamic hosted by Dr Alan Nye & Brook Howells from AQuA. This webinar discussed how to encourage patients, carers and the public to work alongside (in equal partnership) with clinicians and managers
During Expo Day selected Summit Sponsors will showcase their latest initiatives and solutions:
-- Preview the Future of Brain Health with Anu Acharya, Founder and CEO of Map My Genome
-- The Alzheimer’s Research and Prevention Foundation (ARPF): Discuss new science and prevention initiatives with President Dr. Dharma Singh Khalsa.
-- FitBrains (a Rosetta Stone company): Explore ongoing big data research with Conny Lin, Data Research Scientist & Policy Analyst.
Presentation @ The 2015 SharpBrains Virtual Summit http://sharpbrains.com/summit-2015/agenda
THIS CHAPTER DISCUSSES
•The empirical evidence supporting a strengths-based approach
•Specific practice guidelines for recruiting client resources to promote change
•The link between pluralistic counselling and a focus on client strengths
Here is the full report of the NHS Change Model hack event, which took place on Wednesday, 14 October 2015.
There has never been a better time to really scrutinise the way we go about change in health and care. There is a growing body of evidence and practical know-how behind effective and successful change and we must make sure that our change efforts are designed to take full account of the evidence based and lessons learned.
The NHS Change Model has been one of the leading models of change used in the NHS over the past couple of years. We know that some improvement leaders would not be without it and use the model extensively, to underpin and structure all their change activities. We also recognise that there are some change leaders that are not so keen on the NHS Change Model. They have found it hard to apply the model in a practical and useful way and there are others who think that it should be broadened out from just being an NHS-specific model.
The way we lead change must always adapt and evolve with the times and as such, we feel it is timely and opportune to review and revise the NHS Change Model. Our starting point is hearing and understanding exactly what the people leading change in health and care say they need to support them. We want to use methods that fly in the face of tradition and open up new, exciting and creative opportunities.
We organised a hack day for about 80 selected people that brought diverse and wide-ranging perspectives to the table. Hack events have traditionally been associated with technology and programming to solve problems, but we are adapting the concept and applying the same principles to ‘hack’ the NHS Change Model, in just one day. You don’t need any techie skills, just insight, ideas and energy to work with others to think deeply about change and collaborate over how we could do it better.
On the day, we:
Reviewed how change currently happens in health and care and what people leading change need to support them
Reviewed the NHS Change Model
Designed a proof of concept to support and enable change across health and care
James Dias, CEO, and Lucas Dailey, Senior User Experience Designer, will present a workshop, “Designing connected care solutions at the intersection of medicine and finance” on Saturday, September 6th from 2:20-3:50 PM PDT.
The workshop will explore how the business of performance-based healthcare requires a balance between giving patients the best possible quality outcomes and doing it in a cost effective manner. This emphasis on value-driven medicine is producing the opportunity for new technology solutions that address both care and costs. Designing effective solutions for “Connected Care” requires an interdisciplinary approach that brings together the disparate fields of healthcare economics, patient engagement, and digital technology.
The American Association of Occupational Therapy Final Report and Recommendations for the White House Conference on Aging by the American Occupational Therapy Association (AOTA)..
On October 31, 1963 President John F. Kennedy signed into law the Community Mental Health Act (also known as the Mental Retardation and Community Mental Health Centers Construction Act of 1963). It was the last piece of legislation JFK signed before his assassination. For millions of Americans, JFK's final legislation ended the nightmare of being warehoused in institutions and opened the door to a new era of hope and recovery—to a life in the community. The auspicious occasion of the 50th anniversary will appropriately parallel a sustained effort by the Heart and Soul of Change Project to reach those in public behavioral health (PBH). This is the first question of a series of Q and As about public behavioral health and implementation of PCOMS. Mary Haynes wrote this piece about PCOMS, medical necessity, and the "golden thread."
Jim Warren
National Institute for Health Innovation (NIHI)
The University of Auckland
The presentation was accompanied by this video:
http://www.youtube.com/watch?v=jbvmGqmIxXY
Crowdsourced health predictions for 2016 (a free gift of wonder) curated by D...Gautam Gulati, MD,MBA,MPH
2nd ANNUAL EDITION
A crowdsourced flip book of the community’s wildest predictions for health in 2016.
We asked a simple question:
What do you believe will be the single biggest transformational change in health, wellness, or medicine in 2016?
The answers are in. Take a look inside.
This is our free 'gift of wonder' to all of those who inspire us everyday to do the unimaginable, and think the unusual.
Nick Filer - Digital technology transformation of outpatient servicesInnovation Agency
Presentation by Nick Filer, Health Innovation Manchester: How and why to incorporate the patient voice into your change programmes, Digital technology transformation of outpatient services, 2 July 2018, Haydock Park Racecourse
Barry's standard handouts providing a narrative description of what he presents. Includes a discussion of the common factors and the Partners for Change Outcome Management System
How to make care and support planning a two-way dynamic - presentation from webinar held on 1 October 2014
This relates to the first NHS IQ Long Term Conditions Improvement Programmes Wednesday Lunch & Learn Webinar Series. How to make care and support planning a 2 way dynamic hosted by Dr Alan Nye & Brook Howells from AQuA. This webinar discussed how to encourage patients, carers and the public to work alongside (in equal partnership) with clinicians and managers
During Expo Day selected Summit Sponsors will showcase their latest initiatives and solutions:
-- Preview the Future of Brain Health with Anu Acharya, Founder and CEO of Map My Genome
-- The Alzheimer’s Research and Prevention Foundation (ARPF): Discuss new science and prevention initiatives with President Dr. Dharma Singh Khalsa.
-- FitBrains (a Rosetta Stone company): Explore ongoing big data research with Conny Lin, Data Research Scientist & Policy Analyst.
Presentation @ The 2015 SharpBrains Virtual Summit http://sharpbrains.com/summit-2015/agenda
THIS CHAPTER DISCUSSES
•The empirical evidence supporting a strengths-based approach
•Specific practice guidelines for recruiting client resources to promote change
•The link between pluralistic counselling and a focus on client strengths
Here is the full report of the NHS Change Model hack event, which took place on Wednesday, 14 October 2015.
There has never been a better time to really scrutinise the way we go about change in health and care. There is a growing body of evidence and practical know-how behind effective and successful change and we must make sure that our change efforts are designed to take full account of the evidence based and lessons learned.
The NHS Change Model has been one of the leading models of change used in the NHS over the past couple of years. We know that some improvement leaders would not be without it and use the model extensively, to underpin and structure all their change activities. We also recognise that there are some change leaders that are not so keen on the NHS Change Model. They have found it hard to apply the model in a practical and useful way and there are others who think that it should be broadened out from just being an NHS-specific model.
The way we lead change must always adapt and evolve with the times and as such, we feel it is timely and opportune to review and revise the NHS Change Model. Our starting point is hearing and understanding exactly what the people leading change in health and care say they need to support them. We want to use methods that fly in the face of tradition and open up new, exciting and creative opportunities.
We organised a hack day for about 80 selected people that brought diverse and wide-ranging perspectives to the table. Hack events have traditionally been associated with technology and programming to solve problems, but we are adapting the concept and applying the same principles to ‘hack’ the NHS Change Model, in just one day. You don’t need any techie skills, just insight, ideas and energy to work with others to think deeply about change and collaborate over how we could do it better.
On the day, we:
Reviewed how change currently happens in health and care and what people leading change need to support them
Reviewed the NHS Change Model
Designed a proof of concept to support and enable change across health and care
James Dias, CEO, and Lucas Dailey, Senior User Experience Designer, will present a workshop, “Designing connected care solutions at the intersection of medicine and finance” on Saturday, September 6th from 2:20-3:50 PM PDT.
The workshop will explore how the business of performance-based healthcare requires a balance between giving patients the best possible quality outcomes and doing it in a cost effective manner. This emphasis on value-driven medicine is producing the opportunity for new technology solutions that address both care and costs. Designing effective solutions for “Connected Care” requires an interdisciplinary approach that brings together the disparate fields of healthcare economics, patient engagement, and digital technology.
The American Association of Occupational Therapy Final Report and Recommendations for the White House Conference on Aging by the American Occupational Therapy Association (AOTA)..
On October 31, 1963 President John F. Kennedy signed into law the Community Mental Health Act (also known as the Mental Retardation and Community Mental Health Centers Construction Act of 1963). It was the last piece of legislation JFK signed before his assassination. For millions of Americans, JFK's final legislation ended the nightmare of being warehoused in institutions and opened the door to a new era of hope and recovery—to a life in the community. The auspicious occasion of the 50th anniversary will appropriately parallel a sustained effort by the Heart and Soul of Change Project to reach those in public behavioral health (PBH). This is the first question of a series of Q and As about public behavioral health and implementation of PCOMS. Mary Haynes wrote this piece about PCOMS, medical necessity, and the "golden thread."
Jim Warren
National Institute for Health Innovation (NIHI)
The University of Auckland
The presentation was accompanied by this video:
http://www.youtube.com/watch?v=jbvmGqmIxXY
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
Jocelyn Cornwell: How can organisations support patients to lead quality impr...The King's Fund
Jocelyn Cornwell, Director, the Point of Care Foundation and Senior Fellow, The King's Fund spoke on the benefits of involving patients in leadership at our 2013 Leadership Summit. She drew on her experience of the Point of Care Programme and examples from other organisations, including Kingston General Hospital in Canada, to prove that once you involve patients and carers in quality improvements, the changes stick.
Healthcare is undergoing a transformation. Consumers want to make informed choices and take control of their lives, and pharma companies must be ready to meet their needs. This means building a new healthcare ecosystem that places the patient at its center, with the “person” fully engaged in his or her own healthcare. But with this move to person-centric healthcare, payers and providers are no longer the main decision makers.
So what does this mean for today’s marketers?
In this exclusive Social On Us webinar we discuss:
- Where marketing is failing to address healthcare concerns
- How “big data” is a change-driver for a new healthcare ecosystem
- New opportunities for predictive and preventative medical intervention
- Impact of digital healthcare on patient privacy
Presentation of current evidence for promotion of mental wellbeing and prevention of mental disorders. The presentation argues for moving from research to action, using the mental health in all policies approach.
Developing non-clinical approaches and are pathways to fundamental socioeconomic issues that are presented in the primary care and secondary care settings
NICE Master Class final presentation 25 11 14 (including workshops)NEQOS
Collaborating for Better Care Partnership Master Class with NICE: 'Putting Evidence into Practice' - complete ppt slide pack including the workshop ppts and web links.
NICE Guidance implementation pro forma (nov 14)NEQOS
A Guidance implementation pro-forma to support organisations plan and scope their Guidance implementation*
* Disclaimer: This document was developed specifically for a workshop and is not a resource formally endorsed by NICE.
NICE support for commissioning resources (Nov 2014)NEQOS
Presentation from the Collaborating for Better Care Partnership's Master Class with NICE on 25th November 'Putting Evidence into Practice'. Information and resources to help commissioners implement NICE Guidance
Presentation given at 25th November Collaborating for Better Care Partnership Master Class with NICE - Information about the NICE Fellows and Scholars Scheme (to support implementation projects/ programmes)
Executive summary:From Evidence to Practice: Addressing the Second Translatio...NEQOS
Supporting paper for Collaborating for Better Care Partnership Master Class 23rd October 2014: Executive summary 'From Evidence to Practice: Addressing the Second Translational Gap for Complex Interventions in Primary Care'
Supporting paper for NPT Master Class 'Getting ideas into Practice: normalising implementation of complex interventions across the healthcare system' - Collaborating for Better Care Partnership Master Class 23rd October 2014
Master Class 'Getting New Ideas in to Practice' presentation, Normalisation P...NEQOS
Master Class Presentation slides for 'Getting ideas into Practice: normalising the implementation of complex interventions across the healthcare system', Collaborating for Better Care Partnership Master Class with Dr Tracy Finch, Professor Carl May, Dr Tim Rapley.
Using Implementation Science to transform patient care (Knowledge to Action C...NEQOS
Master Class presentation and workshop materials from the NENC AHSN Collaborating for Better Care Partnership's Master Class, led by Professor Jeremy Grimshaw' on 1st September 2014
'Demystifying Knowledge Transfer- an introduction to Implementation Science M...NEQOS
Powerpoint presentation from 'Demystifying Knowledge Transfer: an introduction to Implementation Science' - 28th May 2014.
Facilitated by Professor Jeremy Grimshaw and Dr Justin Presseau
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
Under Pressure : Kenneth Kruk's StrategyKenneth Kruk
Kenneth Kruk's story of transforming challenges into opportunities by leading successful medical record transitions and bridging scientific knowledge gaps during COVID-19.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
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1. ‘To nudge, or not to nudge’
Understanding how behavioural insights can deliver
improved healthcare
Wednesday, 13 January 2016, 10.00am – 4.00pm
Radisson BLU Hotel Durham, Frankland Lane, Durham, DH1 5TA
2. Objectives:
• Enable delegates to gain an in depth understanding of the
‘Nudge’ concept and behavioural insights methodology
• Ensure participants are able to apply nudge/ behavioural
insights in a clinical setting within their organisations
• Promote participant networking to exchange and share their
learning and collaborate on potential nudge plans across
the North East and North Cumbria
• Enable participants to access a suite of resources and
materials to support them in developing these plans and
putting them in to practice.
• Encourage delegates to take their learning back in to their
organisations to share and put this learning in to practice.
3. Understanding and changing behaviour:
applying behaviour insights to health
Dr Jack Bedeman
Public Health Registrar
Department of Health
9. 9
Before we can change
behaviour, we must first
understand it…
10. 10
Michie et al (2011)
COM-B: A simple model to understand
behaviour
Capability Opportunity
Motivation
Attending
hospital
appointments
Behaviour
11. 11
Michie et al (2011)
COM-B: A simple model to understand
behaviour
Capability
Knowledge, skills and
abilities to engage in the
behaviour
Physical
Physical ability to get to
the hospital
Psychological
Understanding of why
you need to go to the
appointment
Attending
hospital
appointments
12. 12
Michie et al (2011)
COM-B: A simple model to understand
behaviour
Opportunity
Attending
hospital
appointments
Outside factors which
make the behaviour
possible
Social
Seen as OK to attend
during work time
Physical
Availability of transport to
get to the hospital
13. 13
Michie et al (2011)
COM-B: A simple model to understand
behaviour
Motivation
Brain processes which
direct our decisions and
behaviours
Automatic
Experiencing symptoms
on the day
Reflective
Concerns about
treatment
Attending
hospital
appointments
16. 16
Here’s an example of a poorly defined outcome
The objective is to reduce pressures on NHS
A&E departments.
The aim is to concisely state what you are trying to achieve.
It’s not clear what reduced pressure
means. What sort of reduction?
All NHS Emergency Departments? And
in all ways? If all (as this implies), we
might be better considering starting small
to prove the concept before rolling out.
‘Pressure’ could mean lots of things.
Better to look at specifics, even if there
are lots of them to consider in sequence.
17. 17
Define the problem you aim to solve
The objective is to reduce by 5 per cent attendance at
Medway Hospital’s A&E department from patients
presenting in non-urgent situations
Ideally start with a quantifiable objective,
even if modified later. Start thinking early
about the size of effect needed for the
project to be worthwhile.
We usually start behavioural insights
projects on a small scale, and then scale
up if we are confident that something is
working.
Try to be as clear as possible about the specific behaviour you want to change
i.e. what, by who, and when.
Most policy challenges involve more than one ‘behaviour’ – and by a variety of
people e.g. patients and staff. It is easiest to consider each separately.
18. 18
Surprise Hyperbolic Discounting Social Learning Priming
Placebo Effect Decoupling Proccrastination Availability
Impact Bias Long-Tailed Risk Social Identity / norms Habit
Anticipation of Reward Simplification Band Wagon Effect Anchoring
Optimism Bias Intertemporal Choice Business Norms Intuition
Messenger Planning Fallacy Key Influencers Hindsight Bias
Loss Aversion Attention Collapse Identity Salience
Status quo bias Hedonic Framing Cognitive Load Gaming
Sunk Costs Defaults Regret Choice Bracketing
Certainty Bias Altruism Social Proof Mental Accounting
Ambiguity Effect Reciprocity Framing Information Avoidance
Endowment Effect Inequity Aversion Commitments Representativeness
Participatory Effect Teachable moment Cognitive Dissonance Over-Extrapolation
Actor-Observer Bias Omission Bias Attribution Error Segregation Effect
Behavioural insights / concepts
21. 21
The revised chart led to much more accurate information (and less errors)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Dose entered correctly Prescriber's contact
number entered
Frequency of medications
entered correctly
Proportionofmedicationorders
Existing chart (n=174)
Improved chart (n=163)
King et al. (2014)
Redesigning the
‘choice architecture’
of hospital
prescription charts.
Forthcoming.
22. 22
A surgical safety checklist reduced deaths and complications following surgery by a third.
Haynes, A et al: A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England J Medicine 2009; 360:491-499
23. 23
Suicide by paracetamol in England and Wales, 1993-2009
Hawton Keith, Bergen Helen, et al. Long term effect of reduced pack sizes of paracetamol on poisoning deaths and
liver transplant activity in England and Wales: interrupted time series analyses BMJ 2013; 346:f403
Legislation reduced the maximum size of the packages to 16 pills (or 32 if sold
at a pharmacy) i.e. less convenient to purchase and retain multiple tablets.
28. 28
“The great majority (80%) of practices in [NHS
Area Team] prescribe fewer antibiotics per head
than yours”.
Three simple actions…
From a trusted authority figure
Personally addressed
29. 29
Old letter ‘nudge’ letter
Bonus A, Berry D: Increasing Uptake of the NHS Health Check . Report of research with Medway Council
to optimise the invitation letter . 2013. available at www.healthcheck.nhs.uk/document.php?o=588
29
33
0
5
10
15
20
25
30
35
old letter nudge
letter
Attendance rate %
DH – Leading the nation’s health and care
32. 32
Fogarty AW, Sturrock N, Premji K, Prinsloo P. Hospital clinicians’ responsiveness to assay
cost feedback: a prospective blinded controlled intervention study. JAMA Intern Med
2013;173:1654–5.
DH – Leading the nation’s health and care
35. 35
DH – Leading the nation’s health and care
CONTROL
INTERVENTION
Group is split into two
groups by random lot
Outcomes are measured
for both groups
Testing behavioural insights
39. 39
1. Advice on behavioural insights and how to
apply these to your policy area
2. Support designing BI interventions
DH BI team
3. Support designing and running BI
experiments and trials
40. 40
Behavioural insights literature
Excellent
summary text
Understanding full
range of behaviours Guide for policy-
makers
COM-B: http://www.implementationscience.com/content/pdf/1748-5908-6-42.pdf
EAST framework: http://www.behaviouralinsights.co.uk/sites/default/files/BIT%20Publication%20EAST_FA_WEB.pdf
41. 41 How to infuence public behaviour
Drink Aware web site
NHS Organ Donation web site
42. Case Study: Quantifying and modifying patient
attendance in a primary care setting.
Dr Roger Dykins,
Corbridge Health Centre
43. HPCA KTP
Overview and outcomes
18th November 2015
KTP Team:
Alexander Tang Northumbria University & Corbridge Medical Group
Prof Glenda Cook Northumbria University
Julie Johnston Corbridge Medical Group
Dr Robin Hudson Corbridge Medical Group
Dr Roger Dykins Corbridge Medical Group
Dr Akhtar Ali Northumbria University
Dr Emma Barron Northumbria University
Hazel Juggins Northumbria University
John Clayton Innovate UK
44. KTP Aim & Objectives
• Data warehousing and data mining of
practice clinical information systems
• Analysing current service activity
• Designing a stratification system for the
management of chronic disease
• Redesigning systems and professional
practice for the management of chronic
conditions in the practice population
• Develop a training strategy for effective
use of the proposed system
• Develop and agree the practice service
model for chronic disease management
• Pilot model and evaluation
Service
development
grounded in
analysis of GP
practice data
30th April 2012
Clinical topics and priorities
Organisation and business
challenges
45. 0
50
100
150
200
250
300
NumberofPatients
Age Group of Patients on 31-Aug-2014
CMG Registered Patients Demographics (2013)
Male Female Male Trendline Female Trendline
0
50
100
150
200
250
300
350
NumberofPatients
Age Group of Patients on Date of Death
CMG Deceased Patients Demographics
Male Female Male Trendline Female Trendline
46. 0
10000
20000
30000NumberofConsultations
Age Group of Patients on Date of Consultation
CMG Activity Type Consultations for Current Patients (2013)
Home Visit Telephone GP Surgery
0
4000
8000
12000
16000
NumberofConsultations
Age Group of Patients on Date of Consultation
CMG Activity Type Consultations for Deceased Patients (2013)
Telephone Home Visit GP Surgery
48. 0
5000
10000
15000
20000
25000
30000
35000
40000
45000
2009 2010 2011 2012 2013
Consultations
Year
CMG Activity Types Consultation between 2009 - 2013
Total Cons GP/ Surgery GP/ Telephone GP/ Home Visit Nurse/ Surgery HCA/ Surgery
GP/Surgery
Nurse/Surgery
Total
GP/Home
GP/Tele
HCA/Surgery
49. Key Messages from the Analysis of Practice Activity
• Increase in total number of consultations per year over 2009 - 2013
• Steady increase in the number of patients having consultations
each year (4.4% increase)
• 1065 (16%) patients with no consultations in 2013
• 41% registered patients on a QOF register
– 61% of the overall 2013 consultation workload
– 53% of GP surgery consultations, and 92% of GP home visits in
2013
• Patients with high consultation activity is not only accounted for by
those on the QOF registers and 80+ population
• 20 patients not on any QOF, HRPP or Housebound register yet they
are in the Top 200 Consultees between 2009 – 2013
– 2.1% of the overall 2013 consultation workload
52. Practice A Workload Clusters
Clusters 0, 2 and 7 include 393 patients (7% of the registered practice population)
accounting for 28% of the total consultations in 2013.
53. Practice B Workload Clusters
Clusters 3, 5 and 7 include 314 patients (4% of the registered practice population)
accounting for 19% of the total consultations in 2013.
54. 0 5000 10000 15000 20000 25000
GP/Surgery
GP/Telephone
GP/Home Visit
Nurse/Surgery
Nurse/Telephone
HCA/Surgery
Number of Consultations
ActivityType
Activity Type Consultation Comparison between HPCA Practices (2013)
Corbridge Medical Group Practice A Practice B
• On average High Users account for 6% of population and 22% of the overall workload
Practice Registered Patients
CMG 6592
A 5650
B 7131
55. 55
Extremely
High Users
20+ cons
Very High
Users
15 - 20 cons
Moderate
High Users
10 - 14 cons
341 patients
4986 GP surgery and
home visit consultations
43.1% workload in 2013
39 patients
1108 cons
9.6% of workload in 2013
122 patients
1388 cons
12% of workload in 2013
219 patients
2490 cons
21.5% of workload in 2013
Traffic Light Thresholds
56. High Users Consultation Alert – EMIS Web
• Limitations with EMIS Web
Protocols & Concepts to
identify difference in
consultation types (surgery,
telephone, home, admin etc.)
• Feasibility to alert user based
on certain read codes only
• How does this or could
change consultations with
patients?
• Across HPCA: Could different
approaches/services be
offered to high user patients?
57. High user alert – GP views/actions
• Surprise when a patient who they did not
expect to be a high user comes into the
surgery
• Patients often see different GP’s and the
alert has supported identification of
these patients
• For some patients the GPs are arranging
telephone reviews in order to move
workload from face to face appointments
into telephone work
• GP suggesting review periods to patients
• GPs have decided to take a closer look at
their top 10 surgery consultees and top
10 home visit consultees to investigate if
there are interventions that may have an
impact on consultations whilst enhancing
quality care
58. Why do patients seek consultations Analysis of
presenting problem titles
GP Surgery & Home Visit consultations (Aug 2014 – July 2015)
Common Presenting Problem Title Patients Occurrence Ratio
Musculoskeletal problems 183 592 3.23
Acute Respiratory 158 370 2.34
Digestive System 155 366 2.36
Dermatology 159 342 2.15
Depression and Anxiety 92 300 3.26
Ear / Nose / Throat 103 190 1.84
Cardiovascular Disease and Stroke 62 188 3.03
Neurological and Nervous System 85 171 2.01
Symptoms / signs and ill-defined conditions 75 132 1.76
Chronic Obstructive Respiratory Disease 36 132 3.67
Urinary Tract Infection - Suspected and Actual 66 108 1.64
Genitourinary 59 104 1.76
Women's Health / Gynaecological / Pregnancy 51 96 1.88
Hypertension 41 88 2.15
Infectious and parasitic diseases 51 87 1.71
Neoplasms 32 86 2.69
Operations / procedures / sites 51 83 1.63
Circulatory system diseases 40 82 2.05
Mental disorders 28 71 2.54
Eye and Sight problems 50 66 1.32
Respiratory system diseases 31 65 2.1
Medication Review and Advice 43 55 1.28
Alcohol 3 25 8.33
10+ Consultations
60. Risk Stratification: GP Consultations
High Risk
Patient
Pathway
Depression
Atrial
Fibrillation
Group 1
(AIC 746)
10
**
Depression 7
Stroke/TIA 5
PAD 5
CHD 3
Heart Failure 3
Female 3
Housebound -3
Rheumatoid Arth. -5
No No
Y
e
s
Y
e
s
Group 2
(AIC 1707)
5
**
Diabetes 6
CKD 4
Female 1
Meds*** 0
Group 3
(AIC 360)
6
**
Dementia 13
Atrial Fibrillation 8
PAD 7
Asthma 6
Age 70-80 yrs.* 5
Group 4
(AIC 938)
5
**
Housebound 6
CKD 3
Stroke/TIA 3
Group 5
(AIC 9138)
5
**
Palliative Care 4
Rheumatoid Arth. 2
Dementia 1
Female 1
Stroke/TIA 1
PAD 1
COPD 1
Meds*** 0
Age 60-70 yrs.* -1
Age 50-60 yrs.* -1
Below 50 yrs.* -1109
275
56
137
160
3
*Age coefficients relative to 50-60 age group; **Numbers roughly equate to extra number of visits and title number in each table is roughly baseline number of
visits; *** Meds is per medication; Consultations are GP Surgery and Home Visits, totalling 11579 in 2013.
Hypertension
Y
e
s
Patients
Consultation
s
5% (616)
11% (1218)
3% (392)
7% (868)
73% (8485)
Key:
61. Presentation suggestive of UTI in
adult
Consider face to face assessment if:
Systemically unwell eg fever
Frail / elderly
Sx of upper urinary tract infection eg flank
pain
Recurrent UTI ?clinical examination - ?Need
for further investigation
If >1+ haematuria repeat urine
dip 2w post treatment (refer if
ongoing sterile microscopic
haematuria on 3 x urine dips over
1 month period)
MSU should be sent when
possible
Treatment of UTI :
3 days of trimethoprim or nitrofurantoin [If GFR >45] - (guided by previous MSU sensitivities) - for Simple UTI
7 days if:
Upper UTI (use coamoxiclav)
Complicated (constipation associated, structurally abnormal urinary tract, urinary retention)
Male
Catheter UTI
Pregnancy (use cephalexin)
Clinical assessment – face to face or
telephone
Urinalysis
• HCA/Nurse dips urine and creates
externally entered consultation to
record result.
• Pass slip to doctor with result
• Retain sample for MSU
• Reception to ascertain from
patient whether suspected UTI
(not cystitis)
• Ask patient to bring urine sample
• pass to HCA/nurse (or duty
doctor if not available) using
protocol with slip
Notes:
Consider self management plan if recurrent
Consider further investigation in repeat sterile MSU eg ?overactive bladder ?malignancy
Consider sexually transmitted pathogens in patients with sterile MSU eg chlamydia / gonorrhea
62. One-Stop-Shop Pilot
Patient
Disease review
Medication
review/med
issue
Current
problems/issues
Managing acute
illness
Skill sharing and
planning more
powerful with 2
clinicians in room
Patient felt cared for
and able to talk about
things that were
important to them
but not normally
discussed
Joint consulting
very helpful
Summary
document about
patient is useful.
Patient: A reminder
of the care plan and
life plan.
Care Plan in some
cases has also had
a real impact
Questionnaire may
have had a
influence on how
patients feel about
their condition
and/or state of
health
63. ‘GPs are amazed at the impact the One Stop Shop chronic disease
review clinic seems to have had on the timelines – genuine changes
seem to have been achieved even though we are uncertain what has
made the difference.’
64. Overall Key Issues
• High service users are not necessarily those with
multimorbidity and older
• There are high services users not included on any registers
• GP consultation thresholds of 10+; 15+;21+ can be used to
identify clusters of intense service users
• Clinical predictors can be used to identify risk for increased
consultation levels
• Increasing consultation levels is not sustainable within
existing service delivery models
• Transformation of service delivery could involve
development of workforce roles; redesign of clinical
pathways for common presenting problems (UTI);
consideration of the workforce skill mix or economies of
scale achieved across practices for intense service users
• Practice data can be used to inform transformation of
service delivery
65. How “Nudge” is Being Used in the Telehealth
Programme North East and Cumbria
Paul Marriott
Independent TECS Consultant (Paul Marriott TECS Ltd)
AHSN NENC Telehealth Programme Lead
TECS Lead Consultant NHS England Strategic Clinical Networks
TECS Clinical Advocate NHS England
66. South of Tyne & Wear
Northumberland
Durham
The South of Tyne &
Wear PCT Telehealth
Project ran from May
2011 to March 2013
Population of around 644,000
3 - Foundation Trusts
3 - PCT’s / CCG
3 - Metropolitan Councils
Sunderland, Gateshead and South
Tyneside
The Origins of Telehealth In Tyne & Wear
67. “The headline findings of Telehealth were mixed. The good news was that
mortality of Telehealth patients over the year of the trial was 46% less
than the control group. Hospital admissions were 18% lower. To me,
these figures should be enough to justify an immediate rollout. I fancy the
idea of increasing my chances of staying alive. But it won't happen –
because the third big finding of the report was that Telehealth would not
save money.”
The Guardian 2nd July 2012
Headlines on the Whole System Demonstrator
Only 3 Conditions were Included in the Trial
71. Annual Average Cost Per Patient by Generation of Equipment
Equipment
Type
1st Year
Capital
Purchase
Cost
Annual
Leasing
Cost
Annual
Maintenance
Cost
Total
1st Generation
Purchased System
£2000 £1000 £3000
2nd Generation
Leased System
£1150 £1150
3rd & 4th Generation
Rapid Deployment
Leased System
£365 £365
SMS Florence
System
NHS Owned
£45 £29 £74
72. Optimum Health
Good Health
Average Health
Signs of Illness
Chronic Illness
Irreversible Illness
Death
WholeLifePerspective
Conception
Death
The Multi Matrix Model Seeks to Cross “The Whole Life Perspective”
73. NHS Florence SMS Simple Telehealth System
SMS
Prompts and
advice
GP Practices
Specialist Clinicians
Community and
Specialist
Nursing
Public Health
And the 3rd Sector
Local Authority Control Room and Adult Social Care
74. Example of Flo Messages
A quick reminder that your Blood Glucose
Reading is due e.g. “BG 6”. Thanks Flo
Your blood glucose reading is fine. Take care
Flo
Your blood glucose reading is a little high
today. Please refer to your management
plan and follow the advice provided. Take
care Flo
Your reading indicates that you might need a
change to your treatment.
Please ring . . . immediately.
Take care Flo
75. RESEARCH ARTICLE
Randomised Trial of Text Messaging on
Adherence to Cardiovascular Preventive
Treatment (INTERACT Trial)
David S. Wald*, Jonathan P. Bestwick, Lewis Raiman, Rebecca Brendell, Nicholas J. Wald
Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ,
United Kingdom
*d.s.wald@qmul.ac.uk
Conclusions:
In patients taking blood pressure or lipid-lowering treatment for the prevention of cardiovascular
disease, text messaging significantly improved medication adherence compared with no text
messaging.
Trial Registration: Controlled-Trials.com ISRCTN74757601
76. Condition Clinical Lead
Heart Failure, Angina etc. FT, GP
COPD and Respiratory etc. FT, GP
Hypertension GP
Diabetes FT, GP
Gestational Diabetes FT
Type 1 Kids T1KZ FT, GP and 3rd Sector
Parkinson’s FT
Rapid Discharge FT
Carers Pathway GP, LA & PH and 3rd Sector
Acquired Head Injury and Stroke FT, GP
Primary Care Step Up Step Down GP
Care and Nursing Home GP, LA
Weight Management FT, GP, LA & PH
Smoking Cessation LA & PH
Remote Wound Dressing Monitoring FT
Community Matron Case Load FT
Alcohol Induced Morbidity FT, GP
FT = Foundation Trust GP = General Practitioner LA & PH = Local Authority & Public Health
Some of the Current Pathways within the North East and Cumbria (there are
now over 220)
Expand and Widen the Number of Telehealth Pathways and Clinicians
78. Patient Outcomes
COPD Patient “I am
much better now as I am
using 02 readings to
prompt using oxygen I
feel my condition is more
controlled now.”
COPD Patient “I like the
reminder text as I would
forget. Prompts me to
think about doing my
breathing exercises
when readings are low. I
like the freedom of doing
the reading more often.”
Heart Patient “Its easy to
use and my son helps
with the readings. Its
great we can now go to
family members for
example at Christmas
and continue to do
readings.”
Young Diabetic “I Don’t
have to come in every
week now which is much
better I have a busy life
and that helps as I have
a another child which I
needed to get looked
after. Costs me £8 on
bus to attend each
appointment at clinic.”
Middle Aged Diabetic
“Really happy with the
service. It’s a
combination of exercise
Programme and
monitoring my health my
control is far better now”
Community Nursing Patients
Feed Back
80. Contact Details
Paul Marriott
Independent TECS Consultant (Paul Marriott TECS Ltd)
AHSN NENC Telehealth Programme Lead
TECS Lead Consultant NHS England Strategic Clinical Networks
TECS Clinical Advocate NHS England
NHS England Northern Senate
Waterfront 4, Goldcrest Way
Newcastle upon Tyne, NE15 8NY
Mob: 07779816519
paul.marriott@nhs.net
marriott.p1@sky.com
www.england.nhs.uk
AHSN North East North Cumbria
Biomedical Research Building
Campus for Ageing and Vitality
Nuns’ Moor Road
Newcastle upon Tyne
NE4 5PL
www.ahsn-nenc.org.uk
81. A Nudge in the Right Direction for Physical
Healthcare within Mental Health and Learning
Disability Services
Alexia Hardy, Physical Healthcare Project Lead
Pauline Smith, Physical Healthcare Project Nurse
82. People with a
SMI die on
average 15-20
years sooner
than the general
population
Approximately 40% of these
service users are obese, compared
to 25% of the general population
(The NHS Information Centre 2014).
Type 2 diabetes – prevalence
2-3 times higher.
People with a SMI are twice as
likely to die from heart disease.
61% of people with schizophrenia
smoke (33% of general population).
(The Abandoned Illness,
Schizophrenia Commission 2012)
NOW DECREASED TO 20%
People with schizophrenia who
develop cancer are 3 times
more likely to die.
Context
83. Clinical Guidelines
NICE: Guidelines for Schizophrenia
(2009 & 2009)
NICE: Smoking cessation in
secondary care: acute, maternity and
mental health services (November
2013)
NICE: Psychosis & Schizophrenia in
Adults (February 2014)
NICE: Physical Health, Obesity, Lipid
Modification, Preventing Type 2
Diabetes, Hypertension (Various
dates)
Government Policy
National Service Framework
(DoH 1999) > SMI Registers
No Health without Mental
Health (DoH 2012)
NHS Outcomes Framework
(DoH 2012)
The Abandoned Illness
(Schizophrenia Commission
2012)
National Audit of
Schizophrenia (2012)
Cardiovascular Outcome
Strategy (2013)
The National Agenda
84. Physical Healthcare Project
2014-16
Business Plan priority to develop
standards required for the
assessment and monitoring of
physical health.
Local CQUIN 2014/15
Health promotion for people with
psychosis accessing community
services focussing on weight
management and smoking
cessation.
GP Engagement Project
2014-17
Aims to improve clinical
communication with GPs
using standardised
electronic referrals and
discharge letters.
National CQUIN 2014/15
Improving physical healthcare to
reduce premature mortality in
people with SMI.
TEWV Physical Health Agenda
Smoke Free Project
TEWV aims to go smoke free
on 9th March 2016 (National No
Smoking Day).
85. Physical
Healthcare
Project 2014-16
EWS
• Bespoke training offered to services
Trust-wide.
• Additional support post training.
EWS audit across all service areas to
monitoring compliance of new procedure
and identify where staff may need further
support.
• EWS Procedure
• Diabetes Management Guideline
• Cardiovascular Guideline
• Staff Engagement Events/Workshops
• Staff and Student Induction
• Patient workshops
• Patient and carer meetings/focus groups
Engagement and
communication
Development of
standards
Training
Audit
• Project Newsletter for staff
• Project update for patients and carers
• Social Media
• Page on Trust intranet
Diabetes Management
• E-learning in line with new guideline.
• Pilot of face to face training.
86. • Involved and engaged staff by asking ‘What
does physical healthcare mean to you?’
• Used staff thoughts and ideas to produce
project banner to emphasise the whole body
in mind.
• National ‘nudge’ and interpretation of NICE.
• Development of standards in a language
suitable for mental health and learning
disability settings.
• EWS Quick Reference Guide to support
recognition and response to the
deteriorating patient.
• Bespoke EWS training delivered within
service areas across the Trust.
Staff Nudge
87. Patient and Carer Nudge
Empowerment
Thought
provoking
Increased
awareness
Informative