DAVID INSIGHT 005 · BEHAVIOUR & INCENTIVES
What are you saving it for?
What are you saving it for?
What are you saving it for?
Preserving an option can be wise. Recognising when to use it is a different skill.
Preserving an option can be wise. Recognising when to use it is a different skill.
Preserving an option can be wise. Recognising when to use it is a different skill.
Somewhere, there is a bottle of wine waiting for a sufficiently good evening.
Somewhere, there is a bottle of wine waiting for a sufficiently good evening.
Somewhere, there is a bottle of wine waiting for a sufficiently good evening.
Not tonight. It’s a school night.
Not tonight. It’s a school night.
Not tonight. It’s a school night.
Not the weekend. We’re not celebrating.
Not the weekend. We’re not celebrating.
Not the weekend. We’re not celebrating.
We save it because we value it. Yet saving can make it harder to use.
We save it because we value it. Yet saving can make it harder to use.
We save it because we value it. Yet saving can make it harder to use.
KEEPING AN OPTION HAS VALUE
KEEPING AN OPTION HAS VALUE
Waiting can make perfect sense.
Waiting can make perfect sense.
Waiting can make perfect sense.
An uncertain future makes flexibility valuable. We will even spend money to keep options open when they hold little interest.1
An uncertain future makes flexibility valuable. We will even spend money to keep options open when they hold little interest.1
WHEN SAVING CHANGES THE VALUE
WHEN SAVING CHANGES THE VALUE
The occasion gets harder to find.
The occasion gets harder to find.
The occasion gets harder to find.
Six consumer studies found that passing over an item could make it feel more special, narrowing the occasions on which using it felt appropriate.2
Six consumer studies found that passing over an item could make it feel more special, narrowing the occasions on which using it felt appropriate.2
Yesterday’s decision to wait can raise today’s bar for acting.
Yesterday’s decision to wait can raise today’s bar for acting.
Yesterday’s decision to wait can raise today’s bar for acting.
THE QUESTION FOR HEALTHCARE
THE QUESTION FOR HEALTHCARE
What are we preserving?
What are we preserving?
What are we preserving?
Consumer experiments do not establish why clinicians delay treatment. But they do suggest a question.
Consumer experiments do not establish why clinicians delay treatment. But they do suggest a question.
Consumer experiments do not establish why clinicians delay treatment. But they do suggest a question.
What does waiting protect, and how will the team recognise when the balance has changed?
What does waiting protect, and how will the team recognise when the balance has changed?
What does waiting protect, and how will the team recognise when the balance has changed?
ANTIBIOTICS
ANTIBIOTICS
Protect the option. Recognise the patient.
Protect the option. Recognise the patient.
Protect the option. Recognise the patient.
Reserve antibiotics are for highly selected resistant infections when alternatives have failed or are unsuitable. Appropriate use depends on the infection, susceptibility, patient and guidance.3
Reserve antibiotics are for highly selected resistant infections when alternatives have failed or are unsuitable. Appropriate use depends on the infection, susceptibility, patient and guidance.3
England’s Start Smart Then Focus toolkit makes reassessment explicit, usually at 48 to 72 hours, or sooner when needed. Review can mean stopping, changing or continuing treatment.4
England’s Start Smart Then Focus toolkit makes reassessment explicit, usually at 48 to 72 hours, or sooner when needed. Review can mean stopping, changing or continuing treatment.4
Delay effective treatment and the infection may worsen. Use antibiotics unnecessarily or inappropriately and you risk avoidable harm and selecting for resistant bacteria.4
Delay effective treatment and the infection may worsen. Use antibiotics unnecessarily or inappropriately and you risk avoidable harm and selecting for resistant bacteria.4
ONCOLOGY
ONCOLOGY
Later is not guaranteed.
Later is not guaranteed.
Later is not guaranteed.
A Canadian myeloma analysis documented patients who died, or progressed without receiving another line of treatment. It does not explain prescribing psychology or establish the best sequence.5
A Canadian myeloma analysis documented patients who died, or progressed without receiving another line of treatment. It does not explain prescribing psychology or establish the best sequence.5
Yet waiting can also be good care. Active surveillance uses scheduled monitoring and conditions for reconsidering treatment.6
Yet waiting can also be good care. Active surveillance uses scheduled monitoring and conditions for reconsidering treatment.6
The aim is an appropriate and defensible decision.
The aim is an appropriate and defensible decision.
The aim is an appropriate and defensible decision.
Even if that decision is to wait.
Even if that decision is to wait.
Even if that decision is to wait.
USE THIS IN YOUR NEXT BRIEF
USE THIS IN YOUR NEXT BRIEF
Give the right time a definition.
Give the right time a definition.
Give the right time a definition.
First ask why the current behaviour makes sense. What does it protect? What practical constraint might still prevent action?
First ask why the current behaviour makes sense. What does it protect? What practical constraint might still prevent action?
First ask why the current behaviour makes sense. What does it protect? What practical constraint might still prevent action?
1. Show the distinction.
1. Show the distinction.
1. Show the distinction.
Use clinician-developed cases where waiting is appropriate, review is warranted or the decision is borderline. Test the signals people notice.
Use clinician-developed cases where waiting is appropriate, review is warranted or the decision is borderline. Test the signals people notice.
2. Make the next step manageable.
2. Make the next step manageable.
2. Make the next step manageable.
Recognising a need does not mean committing to treatment. Clarify the test, discussion or review, and who owns it.
Recognising a need does not mean committing to treatment. Clarify the test, discussion or review, and who owns it.
Recognising a need does not mean committing to treatment. Clarify the test, discussion or review, and who owns it.
3. Make the cue memorable.
3. Make the cue memorable.
3. Make the cue memorable.
“If [agreed signal], [named role] will [review action].” Specify the route and next review. Draw on if–then planning.7
“If [agreed signal], [named role] will [review action].” Specify the route and next review. Draw on if–then planning.7
4. Test recognition, not recall.
4. Test recognition, not recall.
4. Test recognition, not recall.
Can people identify when review is appropriate and act on it? More treatment or switching alone is not evidence of improvement.
Can people identify when review is appropriate and act on it? More treatment or switching alone is not evidence of improvement.
Can people identify when review is appropriate and act on it? More treatment or switching alone is not evidence of improvement.
YOUR KEY QUESTION
YOUR KEY QUESTION
How will they recognise the moment they were waiting for?
How will they recognise the moment they were waiting for?
How will they recognise the moment they were waiting for?
Every “not yet” needs a “when”. Make the trigger for review as clear as the reason to wait.
Every “not yet” needs a “when”. Make the trigger for review as clear as the reason to wait.
Every “not yet” needs a “when”. Make the trigger for review as clear as the reason to wait.
DAVID INSIGHT 005 | WHAT ARE YOU SAVING IT FOR?