Social Marketing in The NHS:Understanding behaviours not just demand

Final Report17 NovemberThis report is solely for the use of client personnel. No part of it may be circulated, quoted, or reproduced for distribution outside the client organisation without prior written approval from McKinsey & Company. This material was used by McKinsey & Company during an oral presentation; it is not a complete record of the discussion.

Michaela Firth DipM MCIM8th June 2010

isNOT ……..

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Urgent and Emergency Care Service Mapping & Social

Marketing Project

Final Report17 NovemberThis report is solely for the use of client personnel. No part of it may be circulated, quoted, or reproduced for distribution outside the client organisation without prior written approval from McKinsey & Company. This material was used by McKinsey & Company during an oral presentation; it is not a complete record of the discussion.

11

12

14

8

2122

23

24

25

2627

28

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33

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4

5

11

16

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18

1

6

7

15914

21013

19

20

3435

12

Locations of unscheduled care facilities in South Central SHA region

Taken From McKinsey & Co / SCPCT Alliance Urgent Care project 2008

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8

2122

23

24

25

2627

28

29

30

31

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33

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15914

21013

19

20

3435

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1

3456789

131416171819

21011121520

2122232425263032333435

272829

31

Accident & Emergency Depts.

Locations of unscheduled care facilities in South Central SHA region

Basingstoke and North Hampshire HospitalAccident and EmergencyHorton Hospital Emergency DepartmentJohn Radcliffe Hospital Emergency DepartmentMilton Keynes General Hospital Accident and EmergencyQueen Alexandra Hospital Accident and EmergencyRoyal Berkshire Hospital Accident and EmergencyRoyal Hampshire County Hospital Accident and EmergencyRoyal Hospital Haslar Accident and EmergencySouthampton General Hospital Accident and EmergencySt Mary's Hospital Accident and EmergencyStoke Mandeville Hospital Accident and EmergencyWexham Park Hospital Accident and EmergencyWycombe Hospital Emergency Medical CentreFrimley Park Hospital

Walk-in CentresBitterne NHS Walk-in CentreShirley NHS Walk-in CentreSlough NHS Walk-in CentreSouthampton (Central) NHS Walk-in CentreSt Mary's Hospital Walk-in CentreMilton Keynes Walk-in Center

Minor Injury UnitsSt Mary's Treatment CenterHaslar Accident Treatment CenterMinor Injuries Unit, St Petersfield Community HospitalCare Centre Abingdon HospitalOut Patients Dept Townlands HospitalOut Patients Dept Witney HospitalAndover MIU, Andover War Memorial HospitalPetersfield MIU, Petersfield HospitalBuckingham Community HospitalWest Berkshire Community HospitalHeatherwood Hospital

MIU / First Aid UnitBicester Community HospitalChipping Norton Community HospitalWallingford Hospital

Urgent Care CentreLymington UCC, Lymington New Forest Hospital

Taken From McKinsey & Co / SCPCT Alliance Urgent Care project 2008

16

Attributes of urgent care services in South Central

* Refused to answer questions, information obtained through websites** X-ray machines are often located within hospitals, and are unavailable for the last couple of opening hours when the hospital is close

*** Nurses who can prescribe a fixed set of medicines (~50) for common conditions **** Have degree qualified nurses

Source: Phone calls to the services, unless otherwise indicated

Always absentOccasionally presentAlways present

Unknown

Buckinghamshire MIU Bucks Comm. Hosp.

Berkshire East WiC Slough*

Isle of Wight (Nothing)

West Berkshire

Hampshire MIU Andover****

Petersfield

Lymington

TC Haslar*

Oxfordshire MIU Abingdon

Witney

Henley

FAU Chipping Norton

Wallingford

BicesterPortsmouth TC St. Mary’s

Milton Keynes WiC MK Walk-in Centre

Berkshire West

MIU Heatherwood

Southampton WiC Shirley

Royal South Hants

Bitterne

UCC

Staff FacilitiesAccess

Drs Nurse X-ray**NPs

Prescrip-tions PGD***

Opens late ( >2100)

Co-located with hosp? SuturesPCT Type Location

Pre-scrip-tions

MIU

17

Attributes of urgent care services in South Central

* Refused to answer questions, information obtained through websites** X-ray machines are often located within hospitals, and are unavailable for the last couple of opening hours when the hospital is close

*** Nurses who can prescribe a fixed set of medicines (~50) for common conditions **** Have degree qualified nurses

Source: Phone calls to the services, unless otherwise indicated

Always absentOccasionally presentAlways present

Unknown

Berkshire East WIC Slough*

Oxfordshire MIU Abingdon

Witney

Henley

FAU Chipping Norton

Wallingford

BicesterPortsmouth TC St. Mary’s

Milton Keynes

WiC

MK Walk-in CentreWIC

Southampton WiC Shirley

Royal South Hants

Bitterne

Staff FacilitiesAccess

Drs Nurse X-ray**NPs

Prescrip-tions PGD***

Opens late ( >2100)

Co-located with hosp? SuturesPCT Type Location

Pre-scrip-tions

ALL WICs , the same NHS brand , but offering different ‘products’

Would Tesco , Premier Travel Inn or McDonalds do this ?

1818

Quantitative surveys

Responses on attitudes and influencers

• Survey design• Phone survey

of 1600 households

• Survey in A&E and WICs of 600 patients

Using social marketing tools, the drivers of behaviour that cause patients to attend A&E with inappropriate conditions were investigated

Cluster analysis leading to Segmentation

Segmentation

1.2

20.0

6.1

19.0

2.6

1.8

9.7

3.4

2.6

4.2

4.9

1.4

0.8

9.4

0.9

16.5

2.5

6.2

4.7

-

1.6

-

-

-

-

-

-

1.4

1.2

16.2

5.8

5.9

7.3

1.1

3.6

1.5

1.1

1.1

4.1

0.8

-

7.8

1.3

20.6

8.7

14.4

5.5

-

8.1

0.9

1.8

0.9

1.5

0.9

-

7.9

5.3

24.9

13.3

13.0

9.4

5.8

14.2

3.9

9.9

2.9

6.6

11.5

1.2

4.5

6.9

31.9

9.1

12.9

6.3

5.9

12.2

3.9

7.6

7.8

9.5

7.5

5.5

11.8

Invincible

• Create a set of clusters based on those who express similar attitudes

• From the clusters derive segments (fewest number of segments that still provide differentiation)

Factor analysis

Clarity on most appropriate factors

• Review factor loading (correlation) to understand how different attitudes are associated with one another

• Select factors for segmentation

Factor1 Factor2 Factor3

0.73 0.04 0.080.68 -0.14 0.13-0.59 0.02 0.09-0.31 -0.15 -0.13

-0.28 0.72 0.00-0.11 0.67 0.130.04 0.62 0.470.32 0.40 0.13

-0.03 0.07 0.810.23 0.05 0.74-0.02 0.20 0.720.38 0.35 -0.42

Qualitative interviews

Output

Activities • 40 patient interviews (in A&E and patient homes)

• Clinician interviews

Hypotheses on attitudinal statements and behaviours to test

Patients are confused about where to seek treatment for urgent but non-emergency conditionsPatient perceptions of severity and level of treatment required for different medical conditions

Source: McKinsey/SMSR patient survey 2008; McKinsey analysis

– If there is a legitimate emergency then the role of A&E is understood

– There is more confusion about what to do with less severe injuries/ailments

– This is confirmed by the responses of patients in A&E when questioned about the injury/ailment that brought them to A&E

• 70% of people questioned in A&E were not particularly worried about their condition

• 62% did not consider their pain level to be a 4 or 5 on a pain scale of 1–5 (5=very painful)

• 71% did not believe that they needed treatment immediately

Seve

rity

of in

jury

Level of care required

First aid1

2

3

4

5

Emergency

Zone of

patient confusion

2020

Six distinct segments of non-urgent A&E users emerged across South Central

One stop resolution

Informed but referred

Worried users

Emotionally attached to hospital

Confused and dissatisfied

Invincible

Brief Description

• Come to A&E because it’s more convenient–no wait for appointment, always open, can get everything resolved at once

• Do not have good perception of GP or A&E quality

• Generally well-informed older patients who know the alternatives • Most of these patients were referred by someone of authority, often

GPs• Have a sense of guilt for using A&E

• Main driver is worry. Believe that their condition is serious emergency• Most females in this segment are carers worried about someone else• Also tend to use GPs and other services fairly often

• Feel that A&E doctors are more qualified than GPs• Have an emotional attachment to hospital because of relatives or

others treated there• Feel hospitals are a dependable resource

• Don’t know alternatives—only know GP or A&E• Higher proportion of immigrants to the UK• Feel that they are treated poorly at hospital

• Young group, mostly male • Believe GP is for minor things and A&E is for major injuries• Tend towards DIY self-care (like gluing cuts)

Segments Size

22%

19%

17%

14%

14%

13%

Likely most relevantsegment for SC PCTs

* Since this project was undertaken across South Central SHA, sample sizes per segment for each individual PCT were fairly small. Most likely segment was selected based on directional indicators and demographics

Source: SMSR/McKinsey In situ survey data September 2008, weighted

2121

And they turn to different ‘influencers’ for information and advice on health and health services

Source: McKinsey/SMSR in situ survey, 2008

20% of some segments ask a non-medical professional in the NHS that they know informally for advice before coming to A&E

Over 70% asked a female rather than a male for advice

42% say they attempted to contact their GP before coming to A&E, but 30% of those people never got past the GP receptionist or the voicemail

20% of people had an injury at work. Many of these people were told by their employers to go to A&E

Sports injuries form a significant part of A&E attendances, and almost 10% of total visits were caused by injuries that happened at sports clubs

Interventions to change behaviour can be targeted through important influencers

Insights on influencers from in situ survey

2222

These segments vary on degree of willingness to change and drivers of behaviour

Segments (bubble sizerepresents size of segment*)

* Size shown in terms of percent of total inappropriate visits to A&E; this does not reflect size of population of each segmentSource: Team analysis

Domain of social marketing

Rational information barriers only

Addictive/compulsive behaviour

Low

High

Will

ingn

ess

to c

hang

e

Driver of behaviour

Confused and dissatisfied

Relatively more difficult to influence

Deeper emotional barriers

Informed but referred

Invincible

One stop resolution

Emotionally attached to local hospital

14%

14%

22%

13%

17%

19%

DRAFT

Relatively easier to influence

Worried user

23

Social marketing insights have led to interventions that will target specific segments to different degrees

Source: McKinsey/OLR/SMSR interviews & surveys 2008, team analysis

Behaviour change interventions

Service redesign interventions

Worried userOne stop resolution Invincible

Emotionally attached to local hospitalProposed Intervention

Educate women on health care and available urgent care services via media and informal community networks

Confused and dissatisfiedFemales Males

Educate non-medical NHS staff on available alternatives to A&E – ‘influence the influencers’

Run targeted interventions and put effective triage and information at the A&E

Improve services (e.g., GP consultation skills) and care pathways of Long Term Conditions

3

4

2

5

1

Most relevant segments for the PCT:One-stop resolution, Worried users, Confused and

dissatisfied, Invincible

Rebrand and reposition urgent care alternatives to the A&E

Informed but referred

Choose well : campaign materials

"In the past you were what you owned. Now you are what you share."

Charles Leadbeater – ‘We Think’