What's up Doc? Did you remember to wash your hands?
A couple of years ago, Atul Gawande described in the New Yorker a study designed by Dr. Peter Pronovost of Johns Hopkins in which he implimented a short checklist to see if it could decrease a frequent problem in intesive care units -- intravenous catheter infections. The results, published in the New England Journal of Medicine, were oustanding; following five simple steps led the rate of catheter related bloodstream infections to drop 66%.The first step was "wash hands with soap."
A recent post on the Nudge blog—hosted by Cass Sunstein and Richard Thaler, authors of the well-known book of the same title—described a different tactic for getting medical personnel to wash their hands: secret agents!
In Maryland, state leaders recently kicked off a program that will send 45 teams of observers to 47 hospitals to record the hand-washing habits of doctors and nurses. Governing Magazine calls the teams spies. They have to be anonymous in order to alleviate the potential Hawthorne effect.
The Hawthorne effect demonstrates that subjects will improve an aspect of their behavior being experimentally measured simply in response to the fact that they are being studied.
The Governing Magazine piece notes that "the main benefits of the Maryland Hospital Hand Hygiene Collaborative are the creation of a system for officials to share best practices and uniformly report progress, and to raise awareness about the importance of keeping hands clean while dealing with patients" (emphasis added). Duh.
Hospital-acquired infections, which account for 1.7 million infections annually, are among the leading causes of preventable death in the U.S.: 100,000 deaths and $30 billion in additional health care costs, according to the Centers for Disease Control and Prevention. Maryland hospitals hope that improving hand washing will reduce such infections and the costs associated with them. Making people more likely to change their behavior simply by watching them—or providing them with a checklist that reminds them to do so—whatever it takes to change their behavior for the safety of us all.
- Vivian Distler's blog
- Login to post comments
-
More on physician hand-washing behaviors
Vivian Distler
It turns out that Stephen Dubner and Steven Levitt of Freakonomics fame are also fascinated by ways to get doctors to wash their hands. In the video below, Dubner recount how a similar study conducted in Australia: doctors self-reported that they washed 73% of the time, but nurse spies observed that they only washed 9% of the time.
Levitt tells of efforts at Cedars-Sinai to promote hand-washing, which included financial incentives in the form of Starbucks gift cards. What finally worked? Using disgusting pictures of the bacteria found on the palm prints of physicians as screensavers. You can read more about it in this Freakonomics blog post, or in their latest book, SuperFreakonomics.