July 2023.

The art of nudging

In a post-Covid era, it is hard to remember a time when contact with your healthcare teams would only come via phone or in the post. Virtual care has become commonplace, and it is accepted that text messages are used by most of the UK population. Recent data from Forrester shows that 76% of people are satisfied with receiving medical care or advice via text message.

As we’ve seen a rise in digital communications, we’ve also noticed an expanding trend of ‘nudging’ to encourage patients to interact or comply with instructions, such as the contact tracing initiative used by the government during the pandemic.

What actually is a nudge?

Nudging is a valuable behaviour modifier which involves sending a message that prompts a patient to take a specific action. The best nudges use clear and concise language in order to make it as easy as possible for the person receiving it to do as they are being asked.

As a strategy, they are simple to implement and are extremely low-cost when compared to other methods of communication, which is essential during this time of recovery when NHS budgets are tight, and resource is low. These nudge text messages can be easily automated at scale, and personalised to deliver critical information directly into the hands of the patient in a digestible way.

Another (if not the most important) benefit is that we often see swift, or even instant results from a roll out. For example, at one of our NHS clients, a nudge message to encourage patient experience feedback responses was switched on at the end of April, and in the following month the response rate rose dramatically from 15% to 18%.

Tackling the backlog

An important objective across the UK is finding ways to tackle long NHS wait lists, with government reports often citing missed appointments and wasted slots as a key issue. Trusts are looking for straightforward and cost-effective methods to reduce Did Not Attends, whilst also not adding workload to an already strained frontline. Automated, scheduled nudging acts as a reminder which is proven to reduce no shows, and text messages cost pennies compared to the average cost of a missed NHS appointment, which is usually around £160.

This approach can also be used to generate an emotional response in the recipient. Some years ago, following in depth research and testing, the NHS discovered that if they added a statement at the end of appointment reminders to say ‘Not attending your appointment costs the NHS £160’, their missed appointments fell by an average of 23%. Another study showed that text reminders approximately doubles the odds of medication adherence.

Alleviating fears and generating trust

As we all know, we’ve seen the switch to SMS communications, particularly for appointment management and test results, grow throughout the pandemic. However, as familiarity with text messaging rises for everyday tasks and correspondence, so does a rise in reports of scams and therefore people’s trepidation when being asked to trust new contacts or share confidential data, especially for healthcare and banking.

One example of effective nudging to reassure patients is when organisations send out a bulk patient awareness message before rolling out with any new digital communications such as patient portal letters or SMS appointment reminders and surveys. Giving this forewarning to the recipient means that they are much more likely to trust future messages once a solution is live.

Use Case: Innovative pre-procedure preparation

Patients who forget to take their bowel prep or incorrectly follow prep instructions are causing a UK average of over 5% of colonoscopy procedures to not go ahead as planned. As well as the inconvenience of patients having to go through the preparation process a second time, these slots are then wasted as they cannot be easily filled on the day; a waiting list patient would not have taken the bowel prep ahead of time too.

Healthcare Communications worked with Kings College Hospital NHS Trust and Barking, Havering and Redbridge University Hospitals NHS Trust on an exciting NHSE-funded project to develop a series of automated nudge texts to tackle this issue, with the aim of encouraging more accurate compliance with bowel prep. These messages are scheduled based on the time of the patient’s appointment, beginning with a standard reminder, then 4 more containing links to instructional videos and prompts at the right times for fasting and bowel prep.

The Trusts saw an impressive reduction in issues with bowel prep, and therefore a reduction in wasted slots at a time when every appointment is precious. KCH reported a 28% drop in failed colonoscopies, which equates to around £130,000 annual savings. In one month, the number of people who accessed the bowel prep support was 98%, and over 85% of patients reported that they did find the text message reminder helpful.

Patient education for an empowered future

Investing in digital health, and getting patients engaged through this method, can put the NHS on a path to preventative and pre-emptive healthcare. Once embedded in your communication strategy, text messages are seen as reliable and trustworthy, and can become a tool for empowering patients with all the information they need to be in the driver’s seat of their own health.

Everyone benefits from implementing a nudging solution, as our overburdened healthcare system battles its way through recovery, automated messaging frees up staff time and helps to tackle the backlog. As things progress, health tech also paves the way for the future, as goals around becoming a ‘Greener NHS’ take centre stage.

We don’t yet know the full potential of nudge messaging in patient engagement and improving outcomes, but all the evidence points to it being an increasingly positive one.


Healthcare Communications works with over 350 NHS hospitals to personalise the healthcare journey from referral to discharge and transform patients lives. We have developed the tools needed to accelerate patient empowerment through engagement solutions such as appointment reminders, instant messaging, patient self-scheduling, PIFU, personal portals, patient experience surveys, and virtual assistants/chatbots. Email enquiries@healthcomm.uk to find out more.