Using behavioural insights to increase patient engagement with validation of hospital waiting lists

Administrative validation of waiting list is where patients are contacted by hospitals in writing to confirm if they still require hospital care or wish to be removed from a waiting list. Many patients do not reply to validation letters. This innovation involved a collaborative redesign of the validation letter, the application of a range of behavioural insights to letter design and testing through a randomised control trial.

Innovation Summary

Innovation Overview

It is good practice for hospitals to undertake validation of waiting lists. In Ireland, the National Treatment Purchase Fund (NTPF) published a national protocol to support the management of waiting lists, The National Inpatient, Day Case, Planned Procedure (IDDP) Waiting List Management Protocol (2017). It states that:

“the purpose of waiting list validation is to: maintain hospital-patient communication during the patient’s waiting list journey,
update the patient record, reduce DNA and patient cancellation rates, provide clean, accurate, up to date waiting list data which reflects the true demand for hospital services.”

Administrative validation is the process whereby hospital administration contacts patients on inpatient and day case waiting lists at pre-planned intervals during the year to ensure that patients are ready, willing, suitable and available to attend a hospital appointment or wish to be removed. The Protocol states that it is compulsory that a formal bi-annual hospital validation is carried out on all inpatient and day case waiting lists over six months. Following publication of the protocol, the NTPF consulted across the HSE on requirements to help its implementation. One of the priority areas identified in this consultation was the need to develop a suite of consistent and effective patient correspondence for use with patients across the health service when managing waiting lists.

The Research Services and Policy Unit, Department of Health engaged with the Process Innovation Director Unit in the NTPF to discuss the possibility of taking a behaviourally-informed and tested approach to developing patient correspondence. It was decided the first project should focus on waiting validation. Because many patients do not reply to validation letters the purpose of this project was to explore whether using behavioural insights in the redesign of the validation letter would help more patients to engage with the validation process. This outcome was measured by lower non-responses from patients.

Innovation Description

Innovation Development

Innovation Reflections

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Year: 2017
Level of government: National/Federal government


  • Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways

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