E27 Managing NHS pressures using behavioural science with Nicola Bonas, Keri Ross & Amanda Nash NHS Devon

Season #2

This episode welcomes award-winning communicators Nicola Bonas, Keri Ross and Amanda Nash.  

Nicola and Keri both work at NHS Devon Clinical Commissioning group soon to be Integrated Care System for Devon. Nicola is the Associate director of communications, involvement and inclusion and Keri Ross is the Senior communications manager.

Amanda is based frontline as Head of communications at University Hospitals Plymouth NHS Trust.

This is a jam-packed episode!

The theme for this show was winter pressures but as you will hear we cover so much more than that including

1: the importance of marketing as a system.

“working as one team with one plan that we all contribute to has been definitely something that we’ve continued to grow and seen massive success from” Nicola Bonas

2:  From the pre-pandemic days. Nicola shares her experience of developing the childhood flu vaccination campaign #thumbsupforcoby. This campaign was based on the tragic death of young Cobi, and driven by his parents.

“it came from a really real place, two parents experience and a community behind them is what led it to be successful” Nicola Bona

3:  Winters here Jon Snow! It’s all year round. For two reasons

  • increased demand is all year
  • resetting social norms takes all year

 “Winter did used to be a very defined time period with a very defined set of pressures that came with it I think those pressures now run right through the years and they have been for the last few years” Keri Ross

4: Insight is the core to the message development. Insight tips from Keri include good relationships with voluntary sector organisations, community groups and networks to draw down resources and expertise such as the  Academic Health Science Networks.

 “Insight is really the core of everything we then design and develop. We need to understand what peoples experiences are of services and what their understanding of services to really know how to reach them and design something that will connect with them and make a difference.” Keri Ross

5: Case study: Think 111 is a campaign built out from insight. An understanding of the need to reset social norms, make it easy and reach people all year round – when they are not in an emergency situation. The team worked with Healthwatch to run qualitative research sessions to understand their audience and why they had attended the Emergency Department.  Because the team evaluates they know that 78% people had tried another service before attending the Emergency Department.

The constant pressure is keeping up with demand

6:  Understanding people is at the heart of what we do: You can do this by reviewing published work too. Lift and shift!

  “Insight is core to behavioural change, its about understanding the people whose behaviour you are looking to change, understanding what motivates them, what barriers they face and what will drive them and sustain them -  intrinsic and extrinsic motivation.  That’s what we’re good at – we always come back to – what do the people that we are trying to influence what are they currently doing and why?”

7: Case study: Reducing Do Not Attends (DNAs) at outpatient appointments

Amanda used the learning from a randomised control study at Barts Hospital (2015) that successfully reduced DNA’s by 3% following some simple word changes in outpatient text message reminders.

Text-based reminders: (messaging not exact)

  1.  Control group received a reminder along the lines of “Remember you have your appointment at xxx on xxxx”
  2.  Easy-call group received a reminder along the lines of your appointment is xxx at xxx to cancel or rearrange call”
  3.  Social norms group received a reminder along the lines of “we expect to see you at xxx at xxxx date 9 out of 10 people attend.”
  4.  Specific costs we are expecting you to attend xxxx not attending costs the NHS xxx ££ xxxx per missed appointment call if you don’t want to attend”

Plymouth University Hospital achieved their lowest ever rate of DNA’s to new and follow-up appointments. To read more about this study click on this link.


Recommended Books

Nicola’s books:

Keri’s book:

Amanda’s books:


3 AHA moments

  • The NHS pressures are constant all year round. Insight will help ensure messaging is as impactful as possible to support pressures.
  •  The team work as a system and draw insight from across organisations and so elevate the standard of their work as they deepen their understanding of the challenge.
  •  Shift and lift! Publish your work so others can benefit. You don’t always need to run qualitative research – start with seeing what’s out there and try it. N


Behaviour Change Marketing Team training days

Your team, your priorities, bespoke day built around behavioural science. Perfect for bringing a team together – at partnership level Integrated Care Service level or your immediate teams.

Book your training day before the end of 10 June and get a special bonus – one -to – one campaign planning session with Ruth.

These 90-minute sessions (RRP£299) take place after the training day where we go step-by-step through your plans to ensure your application of behavioural science is the best it can be.

This can include the insight, behavioural proposition, channels & content, chosen behavioural framework (usually COM_B or E.A.S.T or both) and stakeholder plan.