Improving the management of hospital waiting lists by using nudges in letters: a randomised controlled trial

Objective: A commonly adopted intervention to help to reduce wait times for hospital treatment is administrative validation, where administrators write to patients to check if a procedure is still required. The did not return (DNR) rate to validation letters is substantial. We tested whether the DNR rate was reduced by introducing nudges to validation letters. Methods: Participants from eight public hospitals (N = 2855; in 2017) in Ireland were randomized to receive an existing (control group) or a redesigned validation letter including nudges (intervention group). Results: Participants in the intervention group were less likely not to return it than those in the control group, OR =.756, SE =.069, p =.002. Control and intervention group DNR rates were 23.97% and 19.24%. This is equivalent to 1 in 5 non-responders changing their behaviour because of the redesigned letter. Conclusions: The redesigned letter increased patient compliance with the validation process. The redesign has subsequently been adopted by public hospitals in Ireland.