Improving the management of hospital waiting lists by using nudges in letters: A randomised controlled trial

Highlights

• A lack of response to letters to validate hospital waiting lists is common.
   
• Introducing multiple nudges to validation letters reduced the did not return rate.
   
• The redesigned letter was adopted by all public hospitals in Ireland.
   
• Other countries could use the study's low-cost way to redesign and test letters.

Abstract

Objective

A commonly adopted intervention to help to reduce wait times for hospital treatment is administrative validation, where administrators write to patients to check if a procedure is still required. The did not return (DNR) rate to validation letters is substantial. We tested whether the DNR rate was reduced by introducing nudges to validation letters.

Methods

Participants from eight public hospitals (N = 2855; in 2017) in Ireland were randomized to receive an existing (control group) or a redesigned validation letter including nudges (intervention group).

Results

Participants in the intervention group were less likely not to return it than those in the control group, OR = .756, SE = .069, p = .002. Control and intervention group DNR rates were 23.97% and 19.24%. This is equivalent to 1 in 5 non-responders changing their behaviour because of the redesigned letter.

Conclusions

The redesigned letter increased patient compliance with the validation process. The redesign has subsequently been adopted by public hospitals in Ireland.