We have been talking to doctors and patients at Royal Derby Hospital to evaluate the study interventions using qualitative methods. Doctors have told us in interviews what they think about the financial cost and radiation harm messages, whether they feel their decision-making has been influenced and why. We are holding focus groups with recent hospital inpatients to explore their attitudes to the financial cost message intervention. It is important to have patient involvement in the project, particularly when using costs to influence decision-making that could affect their care.
We will analyse all of these data to improve our understanding of the impact of the interventions and identify barriers to wider adoption of adding cost and harm messages to test results. This type of qualitative work is really useful in learning what does and doesn’t work in strategies to improve efficiency and reduce waste in health care. We would like to thank all of the doctors and patients who are giving up their time to talk to us and we look forward to sharing the findings of these studies.
Ben Young (Research Fellow), July 2018
This week is the one year anniversary of the feedback interventions (blood test and radiation message) going live on the Royal Derby Hospital results system. Later this month we will collect the data on how these simple interventions may have modified demand. The analysis and interpretation always takes a while, but the end is in sight!
Andrew Fogarty, February 2018
While opportunistically using medical reports to provide information to healthcare staff to help them make more judicious decisions may seem like simple common sense, we are actually using a form of intervention that is called a ‘nudge’ intervention that is based on psychological theory.
This was made famous by Richard Thaler, who was recognised for the wide implications of this theory by a Nobel Prize in October 2017. The application with regard to healthcare is an interesting one. Providing radiation feedback to clinicians is difficult to fault, as it is simply taking information from the text books and sharing it. Despite being a doctor for over 25 years, I have already learnt more about the size of the risks of ionising radiation exposure by being involved in this study, and I suspect that my clinical practice may have subtly changed as a result.
Some people consider that costs have no place in the front line of patient care, as it goes against the basic tenets of the NHS. Others think that anything that helps the finite budget of the NHS go a bit further is a good thing, as more people can be treated. I am in the latter camp.
Andrew Fogarty, December 2017