New research from the Olin Business School at Washington University in St. Louis suggests using electronic monitoring to motivate hand hygiene compliance can be a highly effective approach, but requires a long-term plan to prevent a backlash effect.
The research was led by Hengchen Dai, PhD, assistant professor of organizational behavior at Olin. Based on the three-year-long study of hand hygiene among more than 5,200 caregivers at 42 hospitals, electronic monitoring resulted in a large increase in hand hygiene compliance.
Although compliance initially increased, it gradually began to decline after roughly two years, when electronic monitoring was stopped. In fact, the hand hygiene compliance rates dropped below the baseline levels recorded before monitoring even began, suggesting hand-washing habits weren't truly formed.
The researchers had anticipated a potential decrease in compliance after the monitoring ended, but the extent of the drop was surprising.
"We based our prediction on past research about 'crowding out,' whereby caregivers' internal motivation for compliance may have been replaced by external forces associated with monitoring, such as the fear of penalties or punishments for not washing their hands," said Dr. Dai. "When the external stimulus of monitoring was removed, their compliance behavior declined below the initial level as both the external forces and internal motivations were gone. We do not have the data to get into the underlying psychology, but it is certainly worth examining in future research."
In the end, the researchers warned hospital executives not to "monitor and forget" hand hygiene compliance, but to build electronic monitoring into an institution's norms, culture and leadership.
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