Archive for January, 2013

Are we still relying on too narrow a definition of Patient Information?

January 31, 2013

The provision of high quality Consumer Health Information (CHI) – across the NHS, commercial, voluntary and academic sectors is an area growing importance for the following reasons:

  • The greater proliferation of data
  • The increasing demand for transparency and accountability
  • The shift to “Nudging” people rather than simply “nannying” them, requiring more complex interventions to promote pro-social personal health behaviour.

We have previously blogged on the need to properly address key challenges in the provision of health information. Whilst some issues are being addressed, health information providers still don’t always fully appreciate the need to go beyond the “facts”.

The assumption of providers is that patients:

  • Behave as a “consumer”
  • Are ready, search data, trade-off, prioritise (choosing clinical performance over convenience) and choose the best performer
  • Are egocentric and detached

Thus the role of state/provider is “information telling” to mainly assist these assumptions.However the public do not always respond. Instead:

  • There is evidence that people look for short cuts
  • People are overawed by data – discount data that doesn’t fit their view or seen as complex Social process rather than cognitive
  • People make irrational decisions using their own internal logic
  • The process is complex, iterative and emergent – knowledge construction
  • Is based on soft factors, for example, reciprocation, social proof etc

And when it comes to information they:

  • Don’t search it out
  • Don’t understand it
  • Don’t trust it
  • Don’t use it in a rational way to make choices – instead being selective depending on their needs and motivations

Since we previously covered this issue, books like Daniel Kahneman’s book ‘Thinking, Fast and Slow‘ have confirmed the point about the complexity of human engagement. Kahneman describes the two different ways the brain forms thoughts:

  • System 1: Fast, automatic, frequent, emotional, stereotyping, subconscious
  • System 2: Slow, effortful, infrequent, logical, calculating, conscious

However despite all those very relevant points, which broadly support the points we have made in the earlier blog post, we have still seen some in the health information community saying that the provision of factual and rational information is the only real solution, so getting the percentage of people online becomes the key metric without considering the quality of the transaction. This has the danger of leading to even bigger problems when the people fail to respond in the way some health information professionals hope.

How values based segmentation and communication might help?

If we understand levels of motivation and the importance of emotions in delivering messages there are a number of practical ways this can be taken forward. This is an area that TCC has much experience and, along with its understanding of Values Modes, can add value to. Specifically we can:

  • Use the British Values Survey database to understand the groups that are most likely to read the information and yet fail to be motivated by it. This can be supplemented by qualitative research to explore people’s needs, values, world views, motivation and behaviour and how these views relate to accessing and acting on information
  • Produce research that would assist organisations develop more effective approaches in both written and verbal information.

The ability of individuals to access to information will continue to increase and will undoubtedly benefit many. Unless an organisation is mindful and seeks to understand the different values of their audience, and how this shapes their actions, the information it provides will fail to engage and connect with some of its most vulnerable client groups.

Charlie Mansell is Research and Development Officer for The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here. I am grateful to discussions with a number of TCC staff  past and present in the last two years that have assisted me taking forward the points in the earlier TCC blog posting referred to above.


Relationships and Conversations

January 24, 2013

I recently re-read the IPPR’s publication The Relational State: How recognising the importance of human relationships could revolutionise the role of the state, published in November 2012, which argues that improving relationships between those who deliver services and those who receive them are vital to the future of public services. The report also had political implications as the New Statesman reported at the time.

This approach goes beyond the New Public Management approach of targets and markets with its focus on measuring delivery of services and instead is all about understanding the richness of social networks in building resilience and encouraging change, including behaviour change, as an oblique offshoot of those conversations and relationships. There are many tangible aspects where people’s social networks and their relationships with service providers impact on delivery of services as Thomas Neumark of the RSA has commented here and here.

I should at this stage point out that this alternative approach can itself still be measured to ascertain value for money, through new techniques such as Narrative Capture, Social Network mapping and Values Segmentation. This need for change reflects the fact that many of our future challenges in areas such as public finances and public health, are about intractable long-term problems that cannot be resolved through simple solutions and require long-term engagement.

TCC has done some pioneering work with local authorities around effective communication, developing deeper and more empathic training for staff, and working with people in the community to engage with their friends and neighbours, to assist those Council’s in building community cohesion and engaging over service transformation.

This new approach can be summed up straightforwardly as one of Relationships and Conversations. Both are equally important as this recent article in the Guardian Local Government Network shows. The Leader of Lewes Council makes the point very well:

“At Lewes, we’ve taken the first step towards changing our public participation when the council’s cabinet signed up to the Democratic Society’s “principles of local participation”. These principles include our commitment to an openness and transparency that goes far beyond the usual consultation process – “here’s a 200-page PDF, now tell us what you think”.

“We’re looking to change attitudes across the council, so staff feel able to collaborate with anyone inside the authority or beyond to design, test and deliver better public services. At town and parish level we will be starting a series of open policy and participation experiments across the district. It’s important to say this democratic conversation is not the same as consultation, although consultations can be part of it. Instead it is about creating the spaces and the attitudes that support participation – not just from citizen to state, but from citizen to citizen.”

The last point, where he says, “It’s important to say this democratic conversation is not the same as consultation, although consultations can be part of it”,  is important. Relationships and Conversations in order to be real have to be ongoing and open-ended. It made me think that in order to drive forward the idea of the Relational State, perhaps we need a Conversation Institute as much as we  need a Consultation Institute

Charlie Mansell is Research and Development Officer for The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.

Time limited activity in the ‘Grit Society’

January 18, 2013

Today’s weather made me look back at a blog posting I wrote just over two years ago about the community and institutional response to a heavy snowfall. That work seems to have developed further with Sutton’s  Twitter Grit feeds and Lambeth’s Snow Wardens being examples of the current initiatives.

When I wrote about the ‘Grit Society‘ then, the Big Society was all the rage. That seems to have become a much more long-termist approach built around some ongoing programmes of Citizen ServiceCommunity Organisers, social investment and encouraging more giving.

However the weather challenge is the opposite of this. It is short-term and perhaps it is that time limited commitment that makes people more willing to take part as they are not ending up in an open-ended arrangement, just as we saw so much volunteering during the short period of the Olympics by Games Makers.

Whilst some people are motivated to commit to an activity for a long-period, many others are not and an unsegmented approach to this challenge does not work. That is why I think the point I make in my ‘Grit Society blog posting is still relevant:

The issue, then, for Council’s during the cold months is to communicate a range of messages that motivates those who want to help, encourages more people to take part, but reassures those who do not see volunteering as fair compared to what they already feel they contribute. That opportunity for mindful values based communication is the way to turn the current co-operation of this week’s “Grit Society” perhaps into a wider civic participation.

I think this further illustrates the point made by David Halpern, Director of the Behavioural Insight Team at the Cabinet Office, who wrote yesterday that ‘Successful public service design must focus on human behaviour‘. Insight and segmentation is crucial to gaining an understanding of human behaviour in order to make those service design changes work effectively.

Charlie Mansell is Research and Development Officer for The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.

Keeping those New Year’s Resolutions – useful advice from the Government’s ‘Nudge Unit’

January 8, 2013

I was going to write a blog posting on the behavioural background to keeping New Year’s Resolutions, however I have just seen this excellent blog posting from the Cabinet Office Behavioural Insights Team – also more commonly known as the Nudge Unit after the Thaler and Sunstein book on the subject. This seems to cover most of the key strategies and is worth repeating:

1.       Framing incentives as losses rather than gains tends to be more impactful. For example, if your reward for losing 10kg is to go to a concert, buy the ticket now – it will be harder to give it up than to never have received it. Roland Fryer and co-authors conducted an experiment where teachers were given their performance pay up-front and asked to pay it back if they failed to meet their goals. They found that compared to standard performance related pay this increased results by the same amount as reducing class sizes by around 8 pupils.

2.       Commitment devices can help save, or lose weight (though gym membership may not be an effective commitment device).  Karlan and co-authors review a wide literature on commitment devices and find that they are often successful, even when they impose only psychological costs.

3.       Positive goals (“I will eat an apple every day”) are easier to keep than negative goals (“I will not eat ice cream”).  Adriaanse and co-authors randomly selected female participants who wanted to lose weight and found that those who set goals “If I want to snack, I will eat a healthy snack” were significantly more likely to succeed in weight loss, and less likely to snack than those who set goals like “If I want to snack, I will not eat an unhealthy snack”.

4.       Making a public commitment can help people stick to their targets. For example, when people make a public commitment to weight loss (by having their name and target displayed on a bulletin board), on average lost 20% more weight than those who made a private commitment.

5.       Making small, short-term goals can help reach larger, longer term goals. Townsend and Liu, conducted five experiments on people aiming to lose weight or save more money. They found that those who set goals that they perceived to be farther away were more likely to deviate from those goals by spending money or eating cookies.

I would also add collaborating with others to achieve your goal is more likely to generate social proof and social norms that can act as reinforcers of an intention. Further approaches to reinforcing behaviour change are covered in more detail in the Government’s own MINDSPACE Report.

Motivation is important too and those that have a more optimistic mindset, a wide social network and associated values may find it easier to sustain self-efficacy, stay the course and also suffer less ‘willpower depletion’ in carrying out some personal change.

In the end the trick is to use a range of approaches from above to create a new set of habits which can then act as personal ‘default’s that you carry out without thinking. I have previously written about some of the best approaches to create new ‘habits’ here.

Good luck with whatever ‘new year’s resolution’ behaviour change you are committing to.

Charlie Mansell is Research and Development Officer for The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.