Breaking into the NHS

No, not burglary. Digital Catapult had a half-day event on “NHS: The Procurement Minefield” last Monday. The first speaker was Mahiben Maruthappu from NHS England, who listed six big challenges for the NHS, or things that are needed more of: prevention, innovation, self-care, breaking silos and scaling, IT interoperability, and making the financial case. (Most of these sound like they would fit any major organisation really…)

He then listed three focus areas: organisational change to handle new kinds of services and local innovations (no surprise there!), combining innovations to achieve synergies, and achieving national scale. In terms of medical issues, diabetes, cancer and mental health are the three big priorities for the next ten years.

The other speakers weren’t as interesting to my ears, but the panel discussion towards the end had some good nuggets. For example, in answer to a question about how best to get into the NHS as a new service provider, the answers included having inside knowledge, “talking clinical” (i.e. not just business and tech), having a global view, and being adaptable and having perseverance (expect that anything will take years…). Someone even called the NHS “the hardest market to crack”, and recommended going direct to consumers, even if you then have to go to the US and Australia.

Some food for thought there, though mostly confirming the impression I’ve already got from other health and medical startups about the difficulties involved in working (or trying to work, to be more precise?) with the UK national health care system.

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A typology of nudges

We’re working on an assessment tool to use with pubs and bars. The tool is meant to measure how welcoming the venues are to their non-drinking (or “less-drinking”) customers. We have been pondering all the various factors we could include in the tool, and how to classify them.

Having met some people from the Behaviour and Health Research Unit (BHRU) at Cambridge, they pointed me to their paper “Altering micro-environments to change population health behaviour: towards an evidence base for choice architecture interventions” in BMC Public Health. It could just help us get some of our ideas in order too.

The article has a nice typology for “choice architecture interventions in micro-environments”; I’ll just call them nudges from now on. There are nine types of nudges in this scheme:

    • Ambience (aesthetic or atmospheric aspects of the environment)
    • Functional design (design or adapt equipment or function of the environment)
    • Labelling (or endorsement info to product or at point-of-choice)
    • Presentation (sensory properties & visual design)
    • Sizing (product size or quantity)
    • Availability (behavioural options)
    • Proximity (effort required for options)
    • Priming (incidental cues to alter non-conscious behavioural response)
    • Prompting (non-personalised info to promote or raise awareness)

The first five types change the properties of “objects of stimuli”, the next two the placement of them, and the final two both the properties and placement.

I can see how we could use this as a basis for our thinking on the factors we want to measure pubs and bars on. For example, some basics like the choice of non-alcoholic / low-alcohol drinks would be about Availability, display of non-alcoholic drinks could be Presentation, Proximity and also Priming, drinks promotions would be Prompting and Labelling, and staff training could perhaps be about Prompting too?

I can’t instantly think of anything that we couldn’t fit into the typology (although we might need some flexibility of interpretation!). Interestingly, when the Cambridge researchers reviewed the existing literature, they could only find alcohol related nudges of the ambience, design, labelling, priming and prompting types. And not many studies overall, especially compared to research on diet which was the most popular topic for these types of nudges.

On the other hand, we could probably also find at least one metric for every one of the nine types of nudges, but they might not be the most interesting or important ones for this project. But it could still be a useful exercise to go through.

An events event

Eventbrite did a survey of event organisers recently. I like surveys, so filled it in out of curiousity mainly. Ok, we do organise quite a few events with Club Soda so I did have genuine responses to offer to the survey.

The survey results are now out, there was also a big event at the Methodist Central Hall one morning last week to announce them. The report findings aren’t that relevant to me or Club Soda, as the responses and focus is more on much bigger things than what I’m involved in organising. But the panel discussion at the event had some interesting nuggets. Such as that not many people think SEO is among the most important event marketing tools for them, when it really should be, at least according to Eventbrite. Apparently they pay a lot of attention to the way their event pages look like to search engines.

Some other points that we’ve also come across were confirmed. For example that email is still the most important method of communication, and that 50% is a good rule of thumb when you try to estimate the drop-out rate between people signing up for events and those actually turning up (for free events at least, paid-for are not quite that bad of course).

And buzzwords that got mentioned enough times for me to wrote them down were: Content! Experiences! Storytelling! Community! User experience! Similarly, “learning from selfies” is a thing: according to one panelist a good aim for an event organiser is to “create selfie opportunities”.

Nudging Pubs

Nudging Pubs is the final title to a little project that Club Soda completed last year (it was called “the Dalston Burst” at the start). The final report (pdf) from the project is now out, along with a brand new website.

The aim of the project was to answer this question:

How can we encourage pubs and bars to be more welcoming to customers who want to drink less alcohol or none at all?

The report has the findings from our research and experiments, along with recommendations and key messages. And the great news is that Hackney council are funding a second year of this project, for which Club Soda has partnered with Blenheim CDP. We’ll use the Nudging Pubs website for regular updates on the project, but I’ll probably do something occasionally on this blog as well.

Progress with p values – perhaps

The American Statistical Association (ASA) has published their “statement” about p values. I have long held fairly strong views about p values, also known as “science’s dirtiest secret”, so this is exciting stuff for me. The process of drafting the ASA statement involved 20 experts, “many months” of emails, one two-day meeting, three months of draft statements, and was “lengthier and more controversial than anticipated”. The outcome is now out, in The American Statistician, with no fewer than 21 discussion notes to accompany it (mostly people involved from the start as far as I can gather).

The statement is made up of six principles, which are:

  1. P-values can indicate how incompatible the data are with a specified statistical model.
  2. P-values do not measure the probability that the studied hypothesis is true, or the probability that the data were produced by random chance alone.
  3. Scientific conclusions and business or policy decisions should not be based only on whether a p-value passes a specific threshold.
  4. Proper inference requires full reporting and transparency.
  5. A p-value, or statistical significance, does not measure the size of an effect or the importance of a result.
  6. By itself, a p-value does not provide a good measure of evidence regarding a model or hypothesis.

I don’t think many people would disagree with much of this. I was expecting something a bit more radical – the principles seem fairly self-evident to me, and don’t really address the bigger issue of what to do about statistical practice. That question is addressed in the 21 comments though.

It probably says something about the topic that it needs 21 comments. And that’s also where the disagreements come in. Some note that the principles are unlikely to change anything. Some point out that the problem isn’t with p-values themselves, but the fact that they are misunderstood and abused. The Bayesians, predictably, advocate Bayes. About half say updating the teaching of statistics is the most urgent task now.

So a decent statement as far as it goes, in acknowledging the problems. But not much in the way of constructive ideas on where to go from here. Some journals have banned p-values altogether, which sounds like a knee-jerk reaction in the other extreme direction. I’d just like to see poor old p’s downgraded to one of the many statistical measures to consider when analysing data. Never the main one, and definitely not the deciding factor on whether something is important or not. I may have to wait a bit longer for that day.