Recent paper: Improving the management of hospital waiting lists by using nudges in letters: A Randomised controlled trial

Below is the abstract of a recently published with a team of colleagues in Social Science & Medicine. This project has been ongoing since at least 2018 and seeks to improve communication with patients across the Irish Health Service. It is driven by officials in the Irish Department of Health with involvement from academics and researchers in NUIG and ESRI, and input across the hospital and health system more generally. The trial below is a pragmatic trial. The nature of the administrative system did not at the time permit multiple trial arms of a type that would enable isolation of precise mechanisms so the main aim was to combine several elements demonstrating promising effects in the literature into a new letter that could be tested against the status quo. See this page for a detailed description of the policy implications of the trial and results. It is one of several trials and projects ongoing to improve administrative aspects relating to patient interactions in the system (see paper here for a wider summary). The group involved in the project also composed the nucleus of the development of the behavioural change component of the Irish covid response. In general, behavioural science has emerged as a strong capacity for the Irish health system. 

Abstract

Objective

A commonly adopted intervention to help to reduce wait times for hospital treatment is administrative validation, where administrators write to patients to check if a procedure is still required. The did not return (DNR) rate to validation letters is substantial. We tested whether the DNR rate was reduced by introducing nudges to validation letters.

Methods

Participants from eight public hospitals (N = 2855; in 2017) in Ireland were randomized to receive an existing (control group) or a redesigned validation letter including nudges (intervention group).

Results

Participants in the intervention group were less likely not to return it than those in the control group, OR = .756, SE = .069, p = .002. Control and intervention group DNR rates were 23.97% and 19.24%. This is equivalent to 1 in 5 non-responders changing their behaviour because of the redesigned letter.

Conclusions

The redesigned letter increased patient compliance with the validation process. The redesign has subsequently been adopted by public hospitals in Ireland.