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The Telegraph reports that having patients write down the details of their appointment themselves could save the NHS £250 million a year.

Traditional approaches to the problem have included sending reminder letters and putting up posters telling patients how many GP days are lost every year because of “do not attends” (DNAs).

But a small project in Bedfordshire managed to cut the inattendance rate by up to 30 per cent by jettisoning those ideas.

Instead, patients were asked to write down when their appointment was, rather than the receptionist doing it, and repeat back to them out loud the details.

Posters were also put up at the two participating GP surgeries, and messages run on digital tickers, saying: “Ninety-five per cent of people turn up to their appointments on time.”

Steve Martin, director of Influence at Work, a behavioural science consultancy, said the psychology of negative messages was all wrong.

He said: “The vast majority of practices and hospitals tend to have these posters that point out how many people don’t turn up. But that just makes people think it’s normal not to attend.”


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Cass Sunstein is busy working for the Obama administration and Richard Thaler is currently consulting to the coalition government in the UK. This post expresses the independent thoughts of the Nudge blog’s applied behavioralist John Balz.

Where behavioral science meets up with public policy, politics is not far behind. That is the implicit takeaway from the recent House of Lords report’s conclusion that effective policies to change behavior need to use a variety of interventions including traditional financial incentives, regulations, and yes, behavioral nudges.

This is an unsurprising conclusion. You would be hard pressed to read Nudge and conclude that the world’s most complex problems like climate change and obesity are to be solved with a single behavioral tool, or even a group of them. Together, preliminarily successfully behavioral interventions like Opower’s utility statement along with preliminarily less successful interventions like calorie count displays in New York City restaurants underscore the importance of social contexts, evidence-based policy, and further research. Applied behavioral science is an emerging field of innovation, which requires experimentation and failure. Policymakers who are looking for guarantees of success should, to use a favorite word from Nudge, opt-out of the arrangement.

Like other catchy phrases, “nudging” has taken on a life of its own in popular discourse, which is always a double-edged sword. This is evident in the differing accounts of the term’s meaning that government officials offered the committee. Ultimately, the committee settled on describing nudges (p.12 of the report) as interventions that “prompt choices without getting people to consider their options consciously, and therefore do not include openly persuasive interventions such as media campaigns and the straightforward provision of information” – a description that satisfies the committee, but not necessarily a room full of behavioral scientists.

In the blogosphere, Liam Delaney acutely points out that popularization has led many to focus on the term nudge “rather than the core ideas,” and in the process “obscures the really important set of ideas emerging in behavioral economics, very few of which are spoken about in the document.” To the House of Lords committee, nudging is the raw, narrow application of non-regulatory interventions of which there appear to be four (1. Provision of information – although it somehow can’t be “openly persuasive”; 2. Changes to physical environment; 3. Changes to the default policy; and 4. The use of social norms and salience). To an applied behavioral scientist, nudging is part of a broader application of behavioral science principles, which can be understood as an engagement with how a boundedly rational decision maker with a heterogeneous set of material and non-material preferences interacts with the world around them. At such an abstract level, you can understand a policymaker’s desire to quickly descend to the ground. Great. Now how can I apply this to my program?

Policymakers who work with behavioral scientists to identify particular behavioral problems (e.g. Why don’t people save more in their retirement accounts? Why do people fail to take advantage of a social program they’ve started to apply to?) and understand how and why they form are the ones most likely to benefit from behavioral insights – in combination, of course, with other traditional insights. So are those where considerable thought is given to questions about the scalability of a particular behavioral solution. Skipping ahead to technical solutions in the form of handy lists of nudges may be tempting, but is likely to lead to unsatisfactory results.

There is also a much bigger political debate going on in the background of these conversations. Is behavioral science a challenge to the regulatory state or a supporter of it? Is it ideologically left, right, or center? When is a nudge a shove? What constitutes “voluntary”? Are behavioral policies transformative or cute and tiny? Perhaps you think applied behavioral scientists should grapple with these questions. Or perhaps you think they are largely irrelevant to the particular problems and policymakers who work in partnership with them. Like other political debates, these are philosophical ones that can go in circles without reaching clear resolutions. That’s fine. Individual societies with differing social and cultural values will settle on answers to their own level of satisfaction. Either way, applying behavioral science is not a mandate, it is a choice. The applied behavioral scientists and those who would like to engage with them, in the public and private sectors, should (and hopefully will) continue to do so with an openness to scientific experimentation, a commitment to rigor, and an expectation of realism.


Congestion isn’t just a highway problem. It happens on subway systems, too. Zhan Guo, a professor of urban planning and transportation policy at NYU, says that part of this congestion stems from how transportation authorities draw maps of their systems. In his paper, “Mind the Map” (working paper pdf here), Guo looks at the London Underground system and argues that the Tube map “has a tremendous impact on a passenger’s perceptions and his or her usage of the transit system” since “passengers often trust the Tube map more than their own travel experience on deciding the ‘best’ travel path.” Maps are more than two times as influential as actual travel times, even for experienced transit users. The lesson, Guo says, is that maps themselves can become cost-effective ways to ease planning and operation problems.

Transit maps are not scaled models of physical reality. In the London Underground map, for instance, the correlation between actual distance and transit map distance is just .22. Distance in the Underground map represents just 4 percent of the variation of the actual spatial distance between stations.

This distortion affects travelers’ perceived options of final locations, route choices, and the attractiveness of different routes. The biggest misperception is conflating transit map distance with actual travel time. Transfer stations that look “convenient” can be mobbed by crowds, leading to long wait times. Train trips that look “long” on a map can actually be reached more quickly on foot. Ultimately, travelers “(mis)trust a transit map more than their actual experience; they often take a path that looks shorter on the system map but is longer in reality compared with alternative paths.”

Here is one particular example on the Tube:

There are two alternative paths traveling from Paddington to Bond Street station, path 1 transferring at Baker Street and path 2 transferring at Notting Hill Gates (Map a). Path 2 is about 15% slower by in-vehicle time than path 1, and the Notting Hill Gate station is to the opposite direction of the destination Street (Map b). We would expect that few passengers would choose path 2. However, more than 30% of passengers chose path 2, probably because, on the schematic tube map, path 2 is about 10% shorter than path 1, and Notting Hill Gate station is shown to the south not west of Paddington (Map b).

How should planners adjust maps recognizing the influence they have on travelers’ choices?

There are lots of options. They could redraw maps to better reflect actual distance or actual travel times. They could simply post travel times or draw attention to popular, meaning crowded, transfer stations. Planners could take the focus off individual stations and onto areas. They might note “hot” zones where crowds often form. Travelers who don’t mind a bit of inefficiency in their routes might be willing to take “quieter,” if longer, trips – especially if they have a better chance at scoring a seat. Alternatively, planners might actually remove maps and drive customers to other travel planning options, such as a mobile phone, that can direct them to the most efficient route when travelers type in information about their trip. If the map is always going to influence travelers’ decisions, maybe the best strategy is to lessen travelers’ reliance on any visual version of it?

Addendum: Tim Waters observes: “Its amazing how close everything is. When you are in the tube, the distances seem so much further. I remember a few years ago getting the tube between Leicester Square and Covent Garden! The tube map although great for planning journeys really does distort distances.” Hat tip: Martin Delaney

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In his new NYT column, Richard Thaler offers a guiding principle for policymakers thinking about rules around how personal data can and should be collected and disseminated.

If a business collects data on consumers electronically, it should provide them with a version of that data that is easy to download and export to another Web site. Think of it this way: you have lent the company your data, and you’d like a copy for your own use.

This month in Britain, the government announced an initiative along these lines called “mydata.” (I was an adviser on this project.) Although British law already requires companies to provide consumers with usage information, this program is aimed at providing the data in a computer-friendly way. The government is working with several leading banks, credit card issuers, mobile calling providers and retailers to get things started.

More about mydata in the U.K. is here.

Addendum: Thaler talks about his column on NPR’s Marketplace.

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Reader William Bray sends along an interesting example of a congested environment that seems like it could benefit from a nudge (or two). Time Out London explains the problem:

Leicester Square to Covent Garden on the Piccadilly Line. It’s the shortest tube journey in town – less than 300 yards long. It’s the briefest tube journey in town – just 45 seconds from platform to platform. And it’s also the most expensive tube journey in town – four quid to travel a quarter of a kilometre. But does this deter thousands of tourists every year from making the trip? Of course not.

London Underground are worried. Tourists are irresistibly drawn to Covent Garden, teeming as it is with fashionable boutiques, silver-faced mime artists and juggling unicyclists. But Covent Garden station is 100 years old, and struggling to cope. There’s no space to install escalators, so every year 16 million people have to fight their way in and out via the lifts and stairs. A major infrastructure upgrade is long overdue.

London has started a public education campaign–”Please don’t follow the crowd” to encourage people to walk between the two stops. Thanks to the sluggishness of those lifts and stairs, the Time Out writer estimates that the tube ride is 50 percent longer than the above ground walk. Bray thinks tourists are the major problem because they navigate the city using the Underground map. At least on the tube they won’t get lost. Bray thinks some more above ground choice architecture might help.

Why not simply colour code foot print trails from Leicester Square tube to Covent Garden Tube to ease congestion and match sign posts with colours of foot print trails (stickers on the ground) to make it easier to walk than get the tube. This would remove the risk so people would automatically choose to walk. This would be a more pleasant experience for the Tourist so they like London more i.e. spend more money or make a return visit and the commuter has eased congestion.


Assorted links

1) Budgeting is like dieting. You don’t follow through on your plans.

2) Florida prison currency: Honey buns are the new cigarettes.

3) Maybe the nudge work in the U.K. should be more low-key.

4) Top 10 mistakes in behavior change from the Stanford Persuasive Tech Lab. Hat tip: Joseph Clemens.

5) Smartmeters face a public backlash in California.

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While attention has been paid to news about smoking and organ donor policies coming out of the new British government’s “Nudge unit,” there is also word out about plans to experiment with ways to boost tax compliance.

Today, Mr Letwin has also announced that the Behavioural Insight Team is working with HMRC to encourage people to pay their tax bills on time, helping to save the tax payer money and preventing the need to take tougher action. The trials will test the effects of: people’s general preference for keeping in step with their peers (most of whom will have paid their tax); reciprocity (by drawing attention to the vital services paid for by people’s tax payments); and loss aversion (taking action to avoid the increasing costs of leaving tax bills unpaid). The trials will start in February.

More details on the plans are here.

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Spotted by Jon de Quidt, who thinks the statistic that 1 percent of youth commit serious violence sounds like a lot of youth. Wondering what constitutes “serious” violence?

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Richard Thaler was in the U.K. last week meeting with Prime Minster David Cameron and his staff on ways to incorporate the principles of Nudge into public policy.

The group working on the project – dubbed “the Nudge team” – will be examining how to prompt people into making the right decisions about their health and lifestyle through financial incentives.

Among its tasks will be to encourage people to quit smoking and eat more healthily without the need for formal rules.


All 18 Whitehall departments have posted real-time energy monitors that can be tracked online by the public. The monitors are the result of a David Cameron pledge and the handiwork of eco|Driver. The goal of the meters is to reduce carbon emissions across the government. An example: the Ministry of Justice’s energy consumption info is here.

Overall, the concept is great. If only the U.S. government would import the idea. Still, the U.K. monitors could benefit from a bit of tweaking. eco|Driver tells the Nudge blog that Whitehall energy data can be found on one site (data.gov.uk), but not on one page. Being able to compare 18 department usage patterns on a single page would likely help promote larger conservation successes. In addition, the department energy usage data seems to be measured as aggregate totals, but all departments are not the same size.

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