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System transformationA nudge in the right directionInaugural members of Sciana The Health Leaders Network are spending part of their third meeting investigating the potential impact of behavioural economics and behavioural psychology on health care

The 2017 cohort which arrived on Tuesday was introduced to the subject during a plenary discussion on their first full day of the programme

Beforehand members had worked alongside the 2018 cohort to consider how major change can take place in health systems and what approaches to such change work best and why

Engaging with a presentation after lunch members learned behavioural insights could translate into ldquounderstanding how people behave

in practicerdquo so that policy and services can be designed better

Behavioural science can provide an opportunity to explore new solutions in the public health domain where previous studies havenrsquot worked As one of the speakers remarked it can provide ldquoa lens through which to see policy not a set of tools in a toolkitrdquo

In 2008 Richard Thaler and Cass Sunstein published Nudge a book which made it more widely known there were decades of research which suggested many judgments made by humans werenrsquot rational Members were asked to consider ldquoWhat nextrdquo How can we change the world or choice architecture to allow people to make better decisions

A challenge exists to scale successful behavioural science

Thursday June 14 2018

Join in online If yoursquore interested in writing an op-ed style article for the Sciana website either this week or after yoursquove returned home please let Oscar Tollast from Salzburg Global know or email your submission directly to him otollastsalzburgglobalorg

If you intend to write for your organisationrsquos or your own website please make sure to observe the Chatham House Rule (information on which is in your Welcome Pack)

Wersquoll be updating the website with daily meeting summaries and interviews with Sciana members throughout the meeting and afterwards wwwScianaNetworkorg

You can also join in on Twitter with the hashtag sciana and find all your fellow members and their organisations on Twitter via the list twittercomsciananetworklistssciana-2017-cohort

Throughout the meeting we will be taking photos These will be available on the Sciana Network Facebook page facebookcomScianaNetwork shortly after the meeting

If you need non-watermarked images for your own publications please contact Oscar Please credit photos to Salzburg Global SeminarKatrin Kerschbaumer

continues overleaf

projects within health care and other sectors People have to take into account what behaviours they want to change and whose behaviour it is In health and health care this could be the general public people as patients or general practitioners

One of the case studies members explored concerned a UK hospital and an initiative to reduce the number of missed appointments Patients were sent four messages each one carrying a different detail such as cost a contact number and information on how many other patients attended appointments The best performing message reduced missed appointments by 25 per cent The authors of the study which used findings from two randomised controlled trials

indicated there would be 5800 fewer missed appointments if applied over one year in the same location

Members were shown an overarching framework as to how to introduce ideas from behavioural science Any potential changes should be EAST easy attractive social and timely

In our day-to-day lives we have so many people gadgets and signs competing for our interest Something which is attractive could be personalised to help attract someonersquos attention It could optimise incentives and cater to the ego and emotion

One of the speakers suggested that a default option in health care is

to assume there is a knowledge problem among patients Merely providing additional information however is not the solution Technology can help deliver interventions in the moment and when it is appropriate

Members were asked to contemplate if patients werenrsquot engaging with doctors or medical professionals who were they engaging with and how could they be targeted to help spread necessary information

Towards the end of the afternoon members considered further where ldquonudgerdquo could support system transformation and what limits existed

Members took part in table discussions and put forward several ideas As the session came to a close these thoughts were narrowed down further in preparation for Thursdayrsquos programme

The 2017 cohort will look at priming and framing health games to detect early-stage cancer nudging to adhere to protocols and guidelines nudging specialists to act in teams and not in their specific disciplines and nudging patients to choose a second medical opinion

Groups will work on pre-prepared briefings looking at behaviour change in diverse contexts

Anja Leetz ndash We only have one planet and we must jointly address health concernsMaryam Ghaddar

Itrsquos one thing to hold discussions and summits on climate change and environmental impacts on human health Itrsquos a whole different story to implement change For Anja Leetz the executive director of Health Care Without Harm itrsquos equally important to understand that health care professionals can drive change healing both patients and the environment

Bringing to the table a unique perspective on the health sector and what it means to be healthy Leetz joined her peers at Schloss Leopoldskron as a member of the 2018 cohort of Sciana The Health Leaders Network After nine years in her position Leetz still questions how health care is practised and reimagines how services can be provided

Health Care Without Harm has spent more than 20 years working with the health sector to better understand its impact on the environment and become more

sustainable It is a global network of hospitals across Europe the US Latin America and Asia

ldquoItrsquos important that we broaden our understanding of how we deliver health We work on the premise of the Hippocratic Oath first do no harmhellip we have an impact beyond the patientrdquo

Part of Leetzrsquos role is ldquoscanning the horizonrdquo for emerging issues something she admitted allows for an inspiring amount of creativity and capacity-building in her work Observing the environmental data listening to the ongoing climate debate and considering the recent controversy over the Paris Agreement Leetz believes wersquore heading in a dangerous direction

She said ldquoWe have species loss we have climate change we have loss of biodiversityhellip We have only one planet and so we have to have conversations not just at [a] local level national or regional level but

also understanding that we can only jointly solve the challenges that wersquore all facinghelliprdquo

Networking is an essential part of locating these solutions because as Leetz explains achieving faster implementation of national case studies through legislation is vital Partnerships with the World Health Organization the UNDP and others encourage bilateral cooperation

Leetz suggested alliances with other organisations and initiatives such as the Sciana Network could help Health Care Without Harm further increase its impact

ldquoComing to Sciana listening to other peoplersquos challenges makes me feel that our own challenges arenrsquot so uniquehellip itrsquos interesting to see how other people are approachinghellip the question of innovationhellip There are good opportunities to look at improvements [in] how we do our own workhelliprdquo

inter view

This feature has been edited for length and clarity Read the

full version on sciananetworkorg

Anja Leetz ndash We only have one planet and we must jointly address health concernsMaryam Ghaddar

Itrsquos one thing to hold discussions and summits on climate change and environmental impacts on human health Itrsquos a whole different story to implement change For Anja Leetz the executive director of Health Care Without Harm itrsquos equally important to understand that health care professionals can drive change healing both patients and the environment

Bringing to the table a unique perspective on the health sector and what it means to be healthy Leetz joined her peers at Schloss Leopoldskron as a member of the 2018 cohort of Sciana The Health Leaders Network After nine years in her position Leetz still questions how health care is practised and reimagines how services can be provided

Health Care Without Harm has spent more than 20 years working with the health sector to better understand its impact on the environment and become more

sustainable It is a global network of hospitals across Europe the US Latin America and Asia

ldquoItrsquos important that we broaden our understanding of how we deliver health We work on the premise of the Hippocratic Oath first do no harmhellip we have an impact beyond the patientrdquo

Part of Leetzrsquos role is ldquoscanning the horizonrdquo for emerging issues something she admitted allows for an inspiring amount of creativity and capacity-building in her work Observing the environmental data listening to the ongoing climate debate and considering the recent controversy over the Paris Agreement Leetz believes wersquore heading in a dangerous direction

She said ldquoWe have species loss we have climate change we have loss of biodiversityhellip We have only one planet and so we have to have conversations not just at [a] local level national or regional level but

also understanding that we can only jointly solve the challenges that wersquore all facinghelliprdquo

Networking is an essential part of locating these solutions because as Leetz explains achieving faster implementation of national case studies through legislation is vital Partnerships with the World Health Organization the UNDP and others encourage bilateral cooperation

Leetz suggested alliances with other organisations and initiatives such as the Sciana Network could help Health Care Without Harm further increase its impact

ldquoComing to Sciana listening to other peoplersquos challenges makes me feel that our own challenges arenrsquot so uniquehellip itrsquos interesting to see how other people are approachinghellip the question of innovationhellip There are good opportunities to look at improvements [in] how we do our own workhelliprdquo

inter view

This feature has been edited for length and clarity Read the

full version on sciananetworkorg

hot topic

What insights have you gained by looking at different health care systems from a cultural perspectiveJinny Do

ldquoThe question really was how can we implement change We have different kinds of problems maybe but we have very similar approaches that we said we need to have these regional model projects to implement changehellip We need sustainability Maybe this can be done by just including the local and regional people really providing health care services so that we are talking about a learning organisation rather than a top-down leadership management of change processes Different cultures but same approaches to problems might be the solution

rdquoIna KoppDirector German Association of the Scientific Medical Societiesacute Institute for Medical Knowledge-Management (AWMF-IMWi) Philipps-University Marburg Germany

ldquoI have spent quite a lot of time since that session pondering on how the compact between the

public and the NHS works in the UK and [I] really really am struck by the pointhellip that we really believe in equity and universality when it comes to treatment but when it comes to the causes of disease that require treatment - like social determinants - we struggle to think about things in quite the same way That creates a really difficult tension because if we want to try and reduce the need for health care intervention we have to focus upstream But if the public isnrsquot with us [on] that journey how do we manage that so that we can get to where we think we need to berdquoClaire Lemer

Deputy Director Children and Young Peoplesrsquo Health Partnership Associate National Clinical Director for Children Young People and Transition to Adulthood NHS England UK

ldquoThe question is how culture influences the organisation and

we discussed this morning in our Switzerland group that we have the same cultural influences in the health care organisations as we have in the society We were [also] discussinghellip how health care providers coming from abroad bring in their cultural backgroundhellip It is very interesting with bringing in providers from other countries and they also bring in their own [cultural] values and norms and you have to deal with that in your organisation

rdquoJacqueline Martin Director of Nursing and Allied Healthcare Professions University Hospital Basel Switzerland

Do you have an opinion about todayrsquos Hot Topic Join in the conversation on Twitter Donrsquot forget to mention

Sciana