A vital nudge during a crisis

July 15, 2020

Covid-19 has forced healthcare professionals to adapt rapidly in a high pressure situation. Catherine Dale, Programme Director of Patient Safety and Experience, reflects on why it’s vital that healthcare professionals adopt practices that protect them and their colleagues’ health and ensure they are able to provide the best possible care to patients.

Do you know?

  • Nudge is a concept in behavioural economics, political theory, and behavioural sciences which proposes positive reinforcement and indirect suggestions as ways to influence the behaviour and decision making of groups or individuals.
  • Under PM David Cameron, the UK government set up a Behavioural Insights Team in 2010, commonly dubbed a “nudge unit”, to develop policies.
  • Nudge theory can be a powerful tool in helping healthcare professionals adopt behaviours to help them adapt to crisis and rapid change.
  • ‘In April, IPPR reported that 1 in 2 workers felt their mental health had declined since the pandemic started and more than 1 in 5 are more likely to leave the profession after Covid-19’. Source: IPPR

The #OnlyHuman project stemmed from work Health Innovation Network (HIN) was already doing with The Health Foundation on behavioural insights – also known as ‘nudge theory’ – to improve catheter care. Poor catheter care causes infections that can lead to sepsis and even death. The team worked collaboratively with Revealing Reality and H+K Strategies to successfully complete the exploratory phase of a Behavioural Insights Research Project into reducing catheter associated urinary tract infections (CAUTIs) in hospitals and the community setting.

During the pandemic, this work pivoted to develop materials to apply nudge theory to support hundreds of thousands of NHS and care staff who have had to manage rapid change because of Covid-19. For context, the NHS has 1.3 million staff in total.

When Covid-19 hit we were all overwhelmed with many emotions, ranging from fear, a sense of hopelessness, lack of control, confusion, enormous admiration for health service colleagues in clinical roles, fear again and a baffling sense of not being sure of what could be done that would really make a difference.

That’s when we pivoted ideas from a project to create a suite of materials to help healthcare professional manage this enormous change. That project centred on taking a behavioural insights approach to improving catheter care. Catheters are such a normal part of healthcare that we are oblivious to the dangers associated with them – infections that can lead to sepsis and even death.

“We tend to think I’ve got to put the needs of the vulnerable person first, but in order to do this we still need to start by looking after ourselves.”

Unglamorous but life-saving

Catheter care is not typically very glamorous, exciting or innovative. So, even though we know the right things to do to ensure good catheter care – regular checking, trialling without a catheter as appropriate, care planning on discharge from hospital – other things are very likely to take priority. Our project looked at the role that behavioural insights might have in reminding people to do the right thing to ensure safer and more effective catheter care. If interested more information on this project can be found here.

Because of the pandemic, hospital colleagues had quite enough to deal with so our work on catheter care was temporarily paused. But we were lucky enough to be working on a programme funded by The Health Foundation, with colleagues who were experts in behavioural insights. Behavioural insights is commonly known as ‘nudge’ theory. It focuses on the way in which we humans have biases in our thinking that means there is a predictability about how we are likely to behave. You need a nudge where it’s well established what the right thing to do is but for completely understandable and human reasons, we just aren’t doing it. Nudges can be effective in getting us to eat more healthily, do more exercise or to donate blood, for example. So we explored with the team and our funders if it might be possible to use this expertise to nudge people towards doing the right thing in the midst of Covid.

Look after yourself first

The first question was where might we make a difference? In Covid I have felt a significant responsibility around doing something helpful without irritating already busy people. We honed in on something that could help staff look after themselves. The concept in my mind was when you’re on a plane you are instructed to put the oxygen mask on yourself before you tend to your child. This is often the opposite of the way in which people with caring responsibilities tend to think. We tend to think I’ve got to put the needs of the vulnerable person first, but in order to do this we still need to start by looking after ourselves. So this struck us as an area that might need a nudge.

We then thought about how staff wellbeing messages tend either to be pitched at the individual or at those in leadership positions. But other examples have shown that one of most effective wellbeing strategies is to get people to focus on one another as equals or peers – encouraging people to think about their friends and colleagues, checking with them to make sure they’re having a break, drinking enough water, doing ok. If people are doing this for one another, there is a ripple effect because social cues reinforce the behaviour and make it more sustainable.

A suite of ‘nudge’ materials

These concepts have led to the #OnlyHuman campaign. I am very grateful to be working with so many amazing colleagues and to have had the support of The Health Foundation to pivot the work in this direction during Covid. This campaign consists of a suite of material including an editable e-package of resources with simple tips for teams, a teaser animation and social media assets. These resources are based on research findings and informed by a range of experts and health and social care workers. We can’t predict how much of an impact this campaign will have, it might be simply a drop in the ocean of staff wellbeing initiatives, but sometimes you have to throw a pebble into a pond and see where the ripples will land.

We hope you find the tools we have developed interesting and useful – that is our intention. We also hope by sharing our learning and reflections with you this may spark ideas of your own.

We hope the #OnlyHuman campaign demonstrates the wider opportunities for applying behavioural insights to health and social care. Health and social care is delivered by people and at times we do not always do what is best for ourselves. Even with the best of intentions we need to keep being reminded of what we need to do to look after ourselves and our colleagues. That is never more important than when we are under enormous pressure in a crisis.

Further information

Find out more about the #OnlyHuman project and download the resources.

Download now

We’re here to help

If you would like to be the first to hear more about the next phase of this project or have a project that would benefit from a Behavioural Insights approach, we’d love to know.

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Catherine Dale

By Catherine Dale

Catherine has nearly twenty years’ experience in the NHS in London, including more than fifteen years in service improvement and transformation roles; a Masters in Business Psychology and expertise in Experience-Based Co-Design.