Cialdini reaches the NHS/positive language


Cialdini reaches the NHS/positive language

4 minute read | By Colin | Belief change, Communication skills, presentation skills, Presenting Yourself With Impact

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The Guardian and the BBC Today Programme  report the use of influential language and particularly the principles of Dr Robert Cialdini (See his book Influence) is bringing tangible cost improvements for the NHS at no cost.  In particular the cost of missed appointments, no shows and Do Not Attends (DNAs) have been reduced using the principle of ‘social proof” and positive language that we teach on our influecing and leadership workshops.

I was interested to read that in trying to reduce missed appointments some hospitals put up signs on waiting room walls as to how many people failed to turn up – guess what – missed appointents went up! However when they put up signs explaining how many people attended – attendance went up.

If you want something to happen put it in the positive – discuss what you want them to do.

If you give people social proof that other people are doing it then the chances are they will too!

So, now waiting rooms have signs saying how many people attend and ask for help in improving further these figures.

Food for thought? Let us have your feedback.

Full article:

Recently, the result of a fascinating set of studies sponsored by INFLUENCE AT WORK, BDO and the NHS was released. INFLUENCE AT WORK led this research with Dr. Suraj Bassi and Dr. Rupert Dunbar Rees of BDO.

This research examined DNAs (Did Not Attend/No-Shows) in doctor’s offices. DNAs are a significant and costly problem all over.  But according to The King’s Fund, there is an estimated direct loss of £700m annually due to patients failing to come to their appointments or failing to cancel in time.

The goal of this study was to find simple and cheap approaches to reduce DNAs. This pilot study is now being peer reviewed by the Journal of the Royal Society of Medicine.

In one condition patients making their appointment were asked to verbally repeat the date and time for their next appointment before hanging up the phone. This simple and virtually costless change used the Principle of Consistency an led to an immediate reduction in DNAs by 6.7%

In a second condition, which again employed the Principle of Consistency, nurses and receptionists, when making the patient’s next appointment in person, instead of filling out the small white appointment card asked the patient to fill out this card themselves. This small change produced an 18% reduction in DNAs.

A common practice at GPs and within hospitals is to have a very visible sign in waiting areas that highlights the number of DNAs that previous month. This is not only wrongheaded, but encourages exactly the opposite behavior that these medical offices are trying to extinguish. Because the Principle of Social Proof is so powerful, instead of discouraging DNAs, this poster was actually encouraging DNAs by insinuating that it was a very common practice to not show up for medical appointments. Such use of the Principle of Social Proof can work to help or hurt desired activities.

In an attempt to reduce DNAs, the researchers replaced these signs with alternate signs that simply stated the truth, in another way.  The changed sign read that 95% of patients at (the name of the office) turn up for their appointments or call (insert phone number) if they have to cancel.

This strategy (using Social Proof correctly) combined with the appointment card intervention examined above (using the Consistency Principle)  produced a 31.4% reduction in DNAs.

A health economist working within the NHS calculated that if the simple changes tested in this study were employed across the NHS the savings would be the equivalent to the cost of hiring an extra 472 physicians each year.

Now, what can YOU do with these same easy and nearly costless approaches?

For more information about these studies, see this article from The Guardian.


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