By Chris Hermann, PhD
Infection preventionists have a tough job. It’s not easy to change processes in organizations as complex as hospitals. It’s not easy to change the behavior of hundreds of clinicians and hospital staff. While everyone has the same goal in mind – keeping patients safe and making them well – thousands of individual actions taken every day either support or disrupt this goal.
Improving hand hygiene is commonly accepted as the most important foundational piece of reducing healthcare-associated infections. There are a number of methods that IPs can use to motivate clinicians to clean their hands, but these are not all created equally. Some are negative, or even punitive, such as technology that puts a scarlet badge of shame on a clinician’s chest who hasn’t cleaned their hands. As you might imagine, these approaches don’t tend to work very well.
Psychologists since B.F. Skinner’s research in the 1940s have demonstrated that positive reinforcement is more effective than punishment. Punishment tends to suppress behavior rather than change it, and it can cause fear and aggression. But positive reinforcement tends to strengthen desired behavior and boost morale at the same time.
Improving hand hygiene, like most things in life, is best done with the proverbial “carrot” rather than the “stick.” Not only are carrots a more effective tool to motivate behavior, but they leave a much better taste in your mouth.
Gamification is one positive – and effective – method to change behavior. Gamification is using game principles and elements in a situation that does not traditionally lend itself to being a game. It can engage, motivate and influence people. Believe it or not, gamification can successfully be used to improve hand hygiene and reduce HAIs. We’ve seen it work time and again.
We apply gamification to hand hygiene by creating competitions. Competitions are perfectly suited for healthcare because clinicians tend to be highly educated, compassionate, and self-motivated individuals.
You can form teams in a variety of ways – one unit against another, day shift versus night shift, nurses against doctors, or randomly assign clinicians to teams. Pick a set length of time for the competition – four weeks is usually long enough to see an impact, but short enough to hold participants’ attention. Depending on the time of year, you can come up with fun themes for the competition (Valentine’s Day, summer, Halloween, etc.).
Be sure to measure baseline results prior to starting the competition, and let everyone know what their team’s starting point is. After all, as Peter Drucker famously said, “You can’t manage what you can’t measure.”
We recommend updating the teams as to their standings daily, if possible. The more focus, buzz and attention on the competition, the better!
At the end, award prizes, not only for the winning team(s), but also for most improved. Prizes don’t have to be elaborate – you would be surprised how far a dozen donuts or a few cups of coffee go.
It’s much easier and more efficient to change organizational behavior through a fun, positive game than through virtually any other method. And it works. One of our hospital partners, The Medical Center, Navicent Health (MCNH), saw hand hygiene rates more than double and C. diff drop by an incremental 69 percent through our technology, process and gamification.
MCNH had taken an aggressive approach to reducing HAIs during this period, focusing a variety of “best practice” methods on C. diff, MRSA, CLABSI and CAUTI. These efforts took place in seven units. Five of those units acted as control units, and for the other two, our electronic hand hygiene reminder system was also used.
In the five control units, C. diff dropped by 48 percent. In the two units using a hand hygiene monitoring technology, C. diff declined by 81 percent, a full 33 percentage points (or 69 percent) more. For all HAIs, the control units saw a decrease of 46 percent. The units using the monitoring system had an HAI drop of 72 percent, 27 percentage points (or 57 percent) more.
“We know hand hygiene is the No. 1 way to reduce infections,” says Nancy Osborn, RN, CIC, infection prevention manager at MCNH. “We were doing due diligence with direct observation, but weren’t seeing the results we needed.”
Osborn continued, “Staff members are comfortable with the data and how to access it. They can see the shift in group performance and in their own scores. And it’s fun. We have pizza parties for winning teams and a gentle, non-punitive, educational approach.”
MCNH should be lauded for implementing a comprehensive infection reduction program, which had a significant impact on reducing HAIs even without our system. Their efforts, combined with an electronic hand hygiene reminder system and a gamification process, reduced costs, improved patient safety, and ultimately saved lives.
Chris Hermann, PhD, is founder and CEO of Clean Hands – Safe Hands.