Tuesday, September 29, 2009


If you've been unlucky enough to visit your doctor recently, you may have seen a sign reporting how many appointments were missed last month - and possibly how much this was costing. The idea being to shame you, as a potential no-show, into not doing it again. The bigger the figure, the deeper the shame and the stronger the resolve to mend your ways.

But according to Danny Finkelstein's Radio 4 offering, Persuading us to be good, this is precisely the wrong approach. The logic goes that we want to feel part of a group, not isolated. Now being part of the group of patients that don't show is still being part of a group. And the bigger that group, the better it is to be part of. The stigma of having missed your appointment and wasted NHS time, money and resources isn't the main behavioural driver, association with others is. In fact one surgery reported a huge increase in no-shows as soon as they started to make this figure public.

The answer: tell people how many showed up for their appointment, implying that the no-shows are a minority of social outcasts and losers, not even worth a statistic.

I'm not sure just how watertight this approach is, but I do like the realisation that the instinctive, knee-jerk reaction can exacerbate exactly the problem it's meant to solve. And that being in a bad group is better than not being in a group at all.


Unknown said...

Instinctive, knee-jerk reaction? surely not under this government?

Tony Ranzetta said...

Are we encouraged to change behaviour by positive reinforcement of right behaviour or by being enabled to realise our mistakes and to learn from them?

I suspect the answer is both and that some of us will change because we are appalled that 1 in 5 people miss their GP appointments - indeed as we age gradually whilst waiting interminably in the surgery, we will realise that the missed appointments and wasted resources are contributing to our wait and in our anger will imagine all kinds of horrible fates for those who didnt turn up for their appointment that day

BUT as many of us would look favourably on a statistic that showed how many of us had turned up - we would see this as a target to be bettered and incentivised accordingly

(Ignoring the fact that those who miss their appointments never see the signs in the surgery so it truly is a meaningless exercise)

The studies on speed cameras compared to signs saying thank you when you have stayed within the speed limit come to mind.

Those studies were inconclusive too but made for a nice social debate!