How to get doctors to hand hygiene: nudge nudge

Abstract

Introduction: The Nudge Theory has been widely used to improve healthy behavior [1,2] and works as an external cue to memory [3]. The Nudge Theory is based on behavioural economics models that has been applied to move communities towards rational targeted purchasing and ecological preferred behaviour patterns [1,2]. Consumers have been nudged successfully towards lower electricity purchasing patterns through displays of their past and current purchasing pattern. Objective(s): To engage medical staff towards improved hand hygiene compliance. Method(s): An automated hand hygiene surveillance system was installed in an Australian tertiary teaching hospital. The clinicians were taught to access a dashboard for daily compliance rates to be discussed at handover meetings and to use a seven-step approach that included nudging each other on the wards with "Doctor, take a moment". Feedback from clinicians about nudging and rates on both wards from June 2014 to February 2015 were compared. Result(s): During the run-in period prior to introducing nudging the baseline compliance rate was 18% on ward C and 37% on ward D. Preliminary results indicated one ward has improved by 32 percentage points while compliance on ward C remained stable at 15%. Clinicians on ward D reported that they were comfortable working as a team to nudge each other towards a goal of improved daily compliance and it was fun. Conversely, ward C clinicians reported a discomfort with nudging each other and were observed to have a different ward culture than ward D. We will discuss the difference in the staff and leadership on the wards that may explain the opposing attitudes towards nudging. Conclusion(s): Nudging daily compliance rates by nurses and doctors resulted in collegiality and developed a 'team consciousness' about improvement in compliance. Changing hand hygiene compliance must work with different organization cultures on wards for effective change management.