Hand Hygiene Compliance Improves with Incentives

By Joe Caponi, VARBusiness
2:46 PM EDT Wed. Jun. 20, 2007

In topics ranging from hand washing to monkey prostitution, Stephen Dubner brought the study of incentives to the VARBusiness 500 last week. Dubner, co-author of the best-selling business book, "Freakonomics: A Rogue Economist Explores The Hidden Side of Everything," spoke at the VARBusiness 500 awards dinner in New York.

"Economics is the study of incentives," Dubner began, but warned that determining which incentives work can be quite challenging, and requires "asking unpopular questions" to truly change behavior. "Unless you know how the world is working now, it's hard to change it," he stated.

Much of Dubner's talk revolved around the example of the efforts of Cedars-Sinai Medical Center in Los Angeles to cut down on patient illnesses and deaths caused by bacterial infections contracted in the hospital. The hospital's research had demonstrated that the most serious conduit for infections was the doctors themselves, and the hospital embarked on a number of initiatives to remind physicans to simply wash their hands between each patient.

"The doctor's self-reported hand hygiene rate was 74%," according to Dubner, but when nurses were asked to monitor doctor's behavior, they reported a mere 9% hand hygiene rate--causing the VARBusiness audience to gasp.

"It's not that the doctors were deliberately lying, but there was definitely a perception gap," Dubner dryly noted.

A series of incentives were tested: memos; free hand sanitizer; a free-breakfast and psyching session; Starbucks gift cards; and more. Though the incentives were well received, and the doctors understood the stakes, none of the incentives managed to alter behavior over the long term.

What worked? Hospital executives cultured their own palm prints in large petri dishes. The resulting "orgy of pathogens" was photographed, and the image turned into the screen saver for the hospital's PCs. Regularly faced with the visual evidence of the dangers they faced, Dubner reported that the hospital was finally able to achieve its hygiene goals among its doctors.

The moral of the story, according to Dubner: "One: You never know where the best incentives will come from, and two: If you go to a hospital, the first thing to do is ask your doctor to wash his hands."

As for the monkeys: Dubner related some research done by Keith Chen, a Yale economist. In trying to understand human behavior--rational and irrational-- regarding money, he set about seeing what behaviors humans inherit from primates. To do so, he set about teaching monkeys the use of currency.

In a Yale lab, monkeys were taught to exchange coin tokens for their choice of different foods. Soon enough, the monkeys showed brand preferences, understood the nature of trade-offs, handled price spikes and generally displayed the same reactions as humans do.