King’s Fund urges caution on choice
- 25 November 2010
The government should be cautious about patients’ ability to make use of information to choose hospitals, the King’s Fund has warned.
The health policy charity said its latest research showed that simply putting information about the quality of care into the public domain would not result in patients making more informed choices about their care.
It said published information about the quality of services need to be clear, easily understood, consistent and comparable if patients were to make more informed choices.
It also said that patients may need to be guided through the use of ‘nudges’ to make the best choices.
Even then, the charity warned policy-makers that patient choice may not be a strong driver of clinical quality improvement.
Anna Dixon, director of policy at the King’s Fund and one of the report’s authors, said: “Information providers should be cautious about patients’ abilities to make complex decisions without some support.
"Innovative approaches such as using nudges can help, but there needs to be an evidence-based approach to public reporting in future.”
King’s Fund researchers worked on the report in partnership with the London School of Economics and Political Science and IESE Business School.
They used focus groups and online experiments to find out how the design of information influences which hospitals patients choose.
In their report, Choosing a high-quality hospital: the role of nudges, scorecard design and information, the researchers say patients do not have a firm preference for what is important to them in choosing a hospital.
Therefore, they suggest three ‘nudges’ to help people make better choices: pre-selecting the highest quality hospital, asking patients to rank the indicators before they were presented with a list of hospitals that meet them, and asking people to reconsider if they have not chosen the highest quality hospital.
The pre-select nudge performed the worst in terms of the patient ultimately choosing the highest quality hospital. However, patients presented with it did perform better when asked to make another choice a few weeks later, when the nudge was not used.
Patients asked to reconsider their decision made a better choice; but did not necessarily do so on another occasion.
The researchers said they also found that selecting a high quality provider based on clinical quality measures was a difficult task that required a high level of numeracy and said many patients would need support with such complex decisions.
The researchers also found that exposing patients to some of the differences in quality between hospitals and forcing them to consider these difficult trade-offs could increase their dissatisfaction with the choice they make.
“Patients may benefit from information that reassures them that hospitals meet a minimum set of required standards,” the research paper adds.
The report says patients were also suspicious of terms such as ‘missing data’ or ‘data not available’ and said information providers needs to explain what ‘data not available’ means and why it is not available.
Focus group participants also made it clear that they want information about the individual consultant or doctor who would be treating them, information that was relevant to their condition or treatment and which helped them to understand the risks they faced by attending a particular hospital.
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