Now that I'm in university, I kind of miss my parents' little reminders like “wash your hands”, and now as a reluctant 'grownup' you would expect/hope that those reminders somehow sunk in and I practise good hand hygiene right? Well the sad truth is no not all the time. But the scary truth is good hand hygiene isn’t even regularly practised by medical professionals, as one study of the University of Geneva Hospital reports (Pittet et. al., 2000). Researchers found an overall staff compliance rate of 46% to the hospital's recommended hand washing policy, and this was accompanied by a rising rate of nosocomial infection (infection spread due to poor hand hygiene). This called an immediate intervention aimed at increasing good hand hygiene practises. But how did researchers manage to increase staff compliance to 67%? Interestingly, they made use of a compliance tactic I remember from my days in primary school.
The intervention study made use of posters primarily to remind doctors and nurses to wash their hands, but not just any poster, each ward had the task of designing a poster and the best poster would be selected to be used as the poster for the month (sound familiar?). In involving ward members, researchers were able to carefully craft this task so that the ward members strongly identified with the institution's goals. This is an example of Cialdini's consistency principle (Cialdini, 2001). When ward members actively participated in creating posters for this particular issue (forced or not), they deemed this issue a worthy cause and may have felt personal support for this issue even though they might not have thought much of this issue before their poster submission. Now that staffers' perception of the issue has changed to that of a supportive one they must behave in a manner that is consistent with their beliefs – they must wash their hands. This 'competition' between wards also facilitated greater active participation as research has shown that rivalry fuels competitive motivations and ultimately behaviour (Malhorta et. al., 2010).
Researchers also made a special effort to get the heads and more prominent figures in the hospital to participate in the promotion of this program. Their main reasons for doing so could have something to do with the bubble of importance a well respected member of the community brings with them. So by showing interest in an issue that was once quite trivial he brings new emphasis on the importance of such an issue, again helping to shape the rest of the hospital's opinions (Centers et. al., 1970). So just like a school full of children, the same compliance tactics seem to work no matter how old we get. Overall the intervention was a step forward. As displayed in Table 2, a steady increase in compliance to the hand washing policy is observed thought the years and decrease in nosocomial infections was also observed (Figure 3).
Centers, R., Shomer, R. W., & Rodrigues, A. (1970). A field experiment in interpersonal persuasion using authoritative influence. Journal of Personality,38(3), 392-403.
Malhotra, D. (2010). The desire to win: The effects of competitive arousal on motivation and behavior. Organizational Behavior and Human Decision Processes, 111(2), 139-146.
Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S., & Perneger, T. V. (2000). Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. The Lancet, 356(9238), 1307-1312.