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How nudging techniques could help alleviate pressure on GP consultation times and create better health outcomes.

Techniques routinely deployed in commerce could help improve clinical outcomes despite time pressures in GP consultations. Already, Britain has some of the shortest consultations in Europe but emerging pressures may make them feel more squeezed.

But nudging techniques, commonplace in the commercial world, could help GPs to alter patients’ thinking, actions and outcomes without adding a single minute to consultation appointments.

Nudging refers to the practice of using an understanding of heuristics, the ways that people make decisions, to prompt changes in behaviour. Consumers are nudged routinely through the use of music, sounds, smell and advertisers’ language to encourage them to make purchases.

When Amazon tells us that people who bought this also bought that we’re inclined to follow.

General practitioners are well-placed to nudge. Doctors already have many other advantages that High Street brands would die for. First, they are trusted. MORI’s Veracity Index_ consistently puts doctors at the top of the trust table – 91% of us would trust one to tell us the truth. This compares favourably to the person in the street (65%) and politicians (15%).

Doctors are also focused on an area of life that obsesses most people – themselves.

Finally, in a world of big data, doctors have an edge over the likes of Google and Facebook – they know their patients better than their closest friends. Patients’ medical histories are littered with their fears, hopes and anxieties.

How might this help GPs help patients?

Rather than thinking of the GP surgery as the place where consultations take place, see it as the delivery vehicle for a well-being brand experience. The brand promise is to cause patients to feel better than they would otherwise have felt had they not visited their GP.

And like all successful brands, nothing would be left to chance. The words used and experience created is sculpted and refined, based upon learning, to affect consumers’ behaviour – to deliver the brand promise.

So everything from the car park, through to meeting with reception staff, to the choice of reading material, to the posters on the wall, to the words used in the consultation room would be geared towards the delivery of that brand experience.

If you are a GP, look at your current approach and consider how much of the current experience contributes to patients’ well-being. Surgeries that ask patients to push a button to register their presence and watch a screen prompt to signal their appointment, may be missing out on valuable “facetime” that could foster personal relationships.

Making the most of each consultation

Let’s look at this in detail. Start as the patient walks through the front door. It is dull or bright in the room? Is anyone smiling or looking welcoming? Is there music? Are people likely to feel better being there? What could you change to help enhance the sense of well-being of patients (and their carers)?

What do reception staff actually say to incoming patients? Merely saying “Good morning Mr. Smith” will have an impact on Mr. Smith’s state of mind. He will feel “known”, recognised and, depending on the tone of voice, warm. Adding in additional detail – “How is your daughter enjoying university?” – could enhance that feeling of warmth and may, in turn, improve his receptiveness.

Next, consider what patients experience before the consultation starts. Stores use knowledge about how we shop_ to inform the way they sell. Products are located to maximise sales – bread and milk are at the back of the supermarket so that consumers will be exposed to many products before reaching the staples. Exposure creates purchases. As does juxtaposition: beer placed near disposable nappies is more likely to sell to men than placed elsewhere. These “prime” consumers for purchases.

So what about what patients will see and read? Screening daytime TV and exposing patients to on screen advertising may seem like a good idea but is this “content” helping to improve their well-being? Is it priming patients to be ready to share information and to listen to advice?

Now, think about what GPs actually say to patients, the forms of words and phrases that create changes in behaviour. This works in commerce. Words, prompts and layouts are tested and reviewed to maximise consumers’ purchasing behaviours. Amazon, for example, uses norm-based prompts – people who bought this also bought these other things. Such prompts create sales.

A GP who says, “I find that most people find that this helps” is likely influence attitude and behaviour. Why? “I find” is a personal endorsement. “Most people” is a norm based message. “Helps” doesn’t over-promise. Always, such wording must be truthful and evidence-based.

Importantly, the forms of words that work in GP consultations – those that cause people to follow advice and take prescribed medicine – should be shared across the practice. Why? Because that’s how to ensure that learning improves outcomes.

Just as commerce gears everything consumers see, hear, feel and experience towards creating sales, so GPs could start to think about deploying this kind of thinking to nudge patients towards making the right decisions about their health.

When resources are tight, well-executed brands can do a lot of the heavy-lifting, improving outcomes without making the job harder.

Further reading:

GP receptionists could do more to relieve “burden” on patients, study finds – BMJ 2016354 doi: (Published 16 August 2016)

Gilovich, Thomas, Griffin, Dale, and Kahneman, Daniel, 2002, Heuristics and biases: The psychology of intuitive judgment. Cambridge University Press, Cambridge.

Underhill, Paco, 2000, Why we buy: the science of shopping. London, Texere.

Mark Fletcher-Brown is a partner with reputation counsel, a communication consultancy. He has been a journalist, columnist and university lecturer and has written extensively about communication management in articles and books. He has worked with PCGs, CCGs and health trusts as well as housing organisations and over 70 public sector organisations and has lectured on communication in the UK, Cyprus and at Moscow State University.


  • Andrew Foster
    Posted at 18:19h, 19 March Reply

    Interesting article. I do agree that the patient experience could be crafted and curated much better, and that this might be a tool for influencing patients to adopt better health behaviours.

    I have a word of caution from personal experience however. Our surgery used to be located in a functional but unattractive building, a short work from bus routes and a bit “off the beaten track”. 4 years ago, we moved into a beautiful new building near the town centre and bus station, with a library and coffee shop on site. Unnecessary patient appointments have increased significantly, placing a strain on services, waiting times have thus increased and patient satisfaction scores are significantly lower due to the wait.

    In an environment where funding is the same whether a patient comes once or ten times a year, It is possible to make the experience too nice.

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