Published by – Realising the Value

Date of publication – September 2016

“Change is more likely to spread when both statutory organisations and community-based organisations align approaches.”

Realising the Value is a programme led by Nesta and The Health Foundation and funded by NHS England  which aims to develop person and community centred approaches for health and well-being. ‘Spreading Change‘ is one part of this programme and describes itself as an action-focused guide for people who champion these approaches.

I found this report interesting because it comes from the viewpoint of behavioural science. It helps to reassure us that behavioural science isn’t a remote concept and in fact, resonates with many elements of co-production, systems change and social movements. The key difference and often criticism is that it focuses on individuals rather than systemic, structural and cultural factors. But does it have to be either/or? I don’t think we should ignore it and in recent times, research emerging from behavioural science units such as Nudge are receiving increased attention within the health sector.

So, what’s good about ‘Spreading Change’? Firstly, it is accessible to the reader and does what it sets out to do. It promotes the Easy Attractive Social Timely (EAST) framework which has been created by the Behavioural Insights Team (BIT) and shapes the document under each of these headings with recommended activity alongside. This is interspersed with real world examples of how this activity impacts practice.

There were a few of things that resonated with me:

• The importance of reframing risk – holding discussions with colleagues which focuses on the management of risk rather than avoiding it altogether (page 13).
• When communicating to practitioners, managers and commissioners, highlighting the benefits to THEM in the first instance, rather than the people using the services. The current system (e.g. meeting targets) can be geared against practitioners who are driven to help others and instead taps into their motivation to avoid punishment or for personal gain. (page 14).
• People are biased towards the present so focus on what benefits they will see now because they prefer rewards now rather than in the future.
• ‘Lifting and shifting’ programmes from one area to another rarely encourages interventions to spread meaningfully which directly challenges the traditional push to upscale – one size does not fit all (page 15).
• Peers are powerful messengers but we often only think about peer networks between service users. Local information networks appear to be as influential as national guidance in primary care so think doctor to doctor, nurse to nurse, administrator to administrator (page 18).

Behavioural science definitely has its uses. We need to combine this with what we know about complex social systems, if we want a full utility belt to help us tip the balance.

“Efforts which try to affect behaviour change primarily by sharing ever more information are likely to flounder.”

Click here to read the full report.