Big Brother is watching (you wash your hands ... or not)

Emily Mongan
Emily Mongan

I'm one of those people who sings, and occasionally dances, while they drive. Nothing too out of control, of course, but just passionately enough where you might be concerned that I was having a medical issue if you passed me on the freeway.

Cruising at 70 miles per hour, I have no problem singing every role in “One Day More” from Les Miserables. But if I'm stopped at a stoplight with other drivers around and possibly watching me? My hands are at 10 and 2, the radio is at a reasonable level and I'm looking straight ahead.

Those sudden changes in behavior are thanks to what's known as the Hawthorne Effect, a psychological phenomenon that causes people to modify their actions if they know they're being observed. It's what makes office workers switch from scrolling Facebook to doing actual work if they feel someone approaching their desk, or keeps kids in check after a stern “I'm watching” look from a parent.

Not even healthcare providers are exempt from the Hawthorne Effect, as a study released last week has shown. Researchers at Santa Clara Valley Medical Center in San Jose, CA, decided to test how well employees adhered to hand washing guidelines when they knew someone was watching, compared to when they didn't.

The hospital had five infection prevention nurses who were known to employees, and 15 volunteers who were unknown, take more than 4,500 hand washing observations between July and December of last year.

The results? When hospital employees saw the infection prevention workers watching, hand hygiene compliance jumped more than 30%, compared to when the anonymous volunteers were doing the watching. Researchers called the results “surprising,” and said the study makes the case that unknown observers should be used to gather hand washing compliance data.

But what about other areas of compliance in the healthcare world? We've already seen evidence that hidden cameras can catch dubious healthcare workers in the act. How would the number of thefts or abusive incidents in nursing homes change if the employees saw the camera, or even just what they thought was a camera?

Aside from benefitting residents, the Hawthorne Effect could have a positive impact on healthcare workers themselves and the facility overall. If an employee somehow knows he or she is being observed, be it by another worker or some type of surveillance system, it could raise the likelihood that the employee will stick to facility policies and cut the risk of hurting themselves — or the resident — with improper lifting or transferring methods, for example.

Of course I'm not advocating you cover every inch of your facility with surveillance cameras, or implement some sort of snitching program among employees. This isn't “1984.”

But as the results of the Santa Clara study show, the Hawthorne Effect could make or break policy compliance among your employees. And improved compliance and outcomes is worth looking out for.

Follow Emily Mongan @emmongan.


Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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