The King's Fund has warned against the idea that more information is always better and suggests the government should be cautious about patients’ ability to make full use of the 'information revolution'  in a new report, Choosing a high-quality hospital: the role of nudges, scorecard design and information, published today.
The research, conducted in partnership with the London School of Economics and Political Science and IESE Business School, used focus groups and online experiments to find out how the design of information influences which hospitals patients choose. It concluded that simply allowing all information currently available about the quality of care to be put into the public domain would not result in people making more informed choices about their care.
The report findings
The research found that patients do not have firm or stable preferences about what is important to them when choosing a hospital. It also found that despite people's tendency to choose their local hospital rather than travelling further to a hospital with higher ratings of clinical quality,  it is possible to prompt people to pay more attention to the importance of clinical quality by re-ordering information and making some aspects of quality more prominent.
This reinforces the need for information providers to pay attention to how information is presented. It also suggests that there is a real opportunity to influence or 'nudge'  people to pay more attention to clinical quality when choosing a hospital.
However, the report concluded that while the use of nudges has the potential to improve the choices people make, more research is needed to evaluate their effects on decision-making for different groups of people.
Other recommendations include the following.
- Policy-makers must recognise that encouraging patients to select a high-quality provider based on clinical quality measures is a difficult task and requires a high level of numeracy; patients may need support with these complex decisions.
- Given the complexity of decisions faced by patients, patient choice may not be a strong driver of clinical quality improvement.
- Published information about the quality of services needs to be clear, easily understood, consistent and comparable if patients are to make more informed choices.
- Exposing people to differences in quality between hospitals and confronting them with trade-offs made some people feel uneasy. Patients may benefit from information which reassures them that hospitals meet the required standards of care, despite not necessarily ranking highly.
Our view on the findings
Anna Dixon, Director of Policy at The King's Fund and one of the report's authors, said:
'The coalition government has recently set out a vision where patients have better access to information and more control over their care. To help people make informed choices, information providers must ensure information is salient, easy to understand and clearly presented.
'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. Importantly, some people, particularly those who are less numerate, will need support and advice and the opportunity to discuss potential choices if they are to make informed choices about their care.'
Notes to editors:
The Information Revolution is one of a series of proposals for consultation published after the Department of Health's White Paper, Equity and Excellence: Liberating the NHS. It is part of the government’s agenda to create a revolution for patients ‘putting patients first’ – giving people more information and control and greater choice about their care. The information revolution is about transforming the way information is accessed, collected, analysed and used.
Reference to research taken from Patient choice: how patients choose and how providers respond, published by The King's Fund in June 2010.
In 2008, Thaler and Sunstein, authors of Improving decisions about health, wealth and happiness, suggested that it is possible to help people make better choices by designing ‘nudges’ that makes it easier for people to do the ‘right’ things.
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- The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.
- The London School of Economics and Political Science (LSE) studies the social sciences in their broadest sense, with an academic profile spanning a wide range of disciplines, from economics, politics and law, to sociology, information systems and accounting and finance. The School has an outstanding reputation for academic excellence and is one of the most international universities in the world. Its study of social, economic and political problems focuses on the different perspectives and experiences of most countries. From its foundation LSE has aimed to be a laboratory of the social sciences, a place where ideas are developed, analysed, evaluated and disseminated around the globe. Visit http://www.lse.ac.uk for more information.
- IESE, the business school of the University of Navarra, is one of the world’s top ten business schools and has pioneered business education in Europe since its founding in 1958 in Barcelona. IESE distinguishes itself in its general-management approach, extensive use of the case method, international outreach, and emphasis on placing people at the heart of managerial decision making. With a truly global outlook IESE, with two campuses in Madrid and Barcelona, a center in New York and offices in Munich and Sao Paolo, currently runs executive-education programs on four continents.