Harvard Case - Nudging Hand Hygiene Compliance at the Brigham and Women's Hospital
"Nudging Hand Hygiene Compliance at the Brigham and Women's Hospital" Harvard business case study is written by John Beshears, Michael Luca, Alister Martin, Simin Gharib Lee. It deals with the challenges in the field of Negotiation. The case study is 7 page(s) long and it was first published on : Mar 16, 2018
At Fern Fort University, we recommend a multi-pronged approach to improve hand hygiene compliance at Brigham and Women's Hospital, focusing on a combination of behavioral nudges, technology and analytics, and employee incentives. This strategy aims to address the complex interplay of factors influencing hand hygiene behavior, leveraging a strategic alliance between the hospital's leadership, healthcare professionals, and patients.
2. Background
Brigham and Women's Hospital, a renowned academic medical center, faced a persistent challenge in maintaining optimal hand hygiene compliance among its staff. Despite the hospital's commitment to corporate social responsibility and patient safety, the compliance rate remained below the desired level. This case study explores the hospital's efforts to improve hand hygiene compliance through various interventions, including organizational culture, leadership, and technology.
The main protagonists of the case study are:
- Dr. Eli Perencevich: The hospital's Chief Quality Officer, spearheading the initiative to improve hand hygiene compliance.
- Dr. Michael Zinner: The hospital's Chief of Infectious Diseases, providing expertise on the importance of hand hygiene in preventing infections.
- Hospital staff: The target audience of the hand hygiene interventions.
3. Analysis of the Case Study
The case study highlights the complex nature of improving hand hygiene compliance. It reveals the following key issues:
- Organizational Culture: The hospital's culture was not conducive to consistently adhering to hand hygiene guidelines. This is evident in the staff's perception of hand hygiene as a chore and the lack of clear accountability for compliance.
- Leadership: The hospital leadership lacked a clear and consistent message regarding the importance of hand hygiene. This resulted in a lack of buy-in from staff and a fragmented approach to implementation.
- Technology: While the hospital implemented technology solutions like hand hygiene monitoring systems, these were not effectively integrated with other interventions. This limited their impact on behavior change.
- Employee Incentives: The hospital's incentive program for hand hygiene compliance was not sufficiently motivating or tailored to individual staff needs. This resulted in limited effectiveness in changing behavior.
Framework: We can analyze this case using the Theory of Planned Behavior (TPB) framework, which posits that behavior is influenced by attitudes, subjective norms, and perceived behavioral control.
- Attitudes: Staff may hold negative attitudes towards hand hygiene, perceiving it as time-consuming or inconvenient.
- Subjective Norms: Staff may feel pressure from colleagues or superiors to prioritize other tasks over hand hygiene.
- Perceived Behavioral Control: Staff may lack confidence in their ability to comply with hand hygiene guidelines, especially in busy or stressful situations.
4. Recommendations
To address these challenges, we propose the following recommendations:
1. Nudge-Based Interventions:
- Visual Cues: Implement prominent visual cues throughout the hospital, such as posters, signage, and hand sanitizer dispensers strategically placed near patient rooms and common areas.
- Social Norms: Utilize social norms messaging to highlight the high compliance rates of other staff members. This can be achieved through public displays of compliance data and peer-to-peer recognition programs.
- Framing: Frame hand hygiene as a positive act of patient care, emphasizing its role in preventing infections and promoting well-being.
2. Technology and Analytics:
- Real-time Feedback: Implement a real-time feedback system that provides staff with personalized feedback on their hand hygiene compliance. This can be achieved through wearable devices, mobile apps, or automated reminders.
- Data-Driven Insights: Analyze hand hygiene data to identify areas with low compliance and tailor interventions accordingly. This can involve identifying specific departments, time periods, or patient populations with lower compliance rates.
- Gamification: Introduce gamification elements into hand hygiene compliance programs, such as points, badges, and leaderboards, to increase engagement and motivation.
3. Employee Incentives:
- Tailored Incentives: Offer a variety of incentives tailored to individual staff preferences, such as gift cards, paid time off, or professional development opportunities.
- Public Recognition: Publicly recognize staff members who consistently demonstrate excellent hand hygiene compliance. This can be achieved through awards ceremonies, newsletters, or social media campaigns.
- Peer-to-Peer Recognition: Encourage peer-to-peer recognition programs, where staff members can acknowledge and reward each other for their hand hygiene compliance.
5. Basis of Recommendations
These recommendations consider the following factors:
- Core Competencies and Consistency with Mission: The recommendations align with the hospital's mission of providing high-quality patient care and promoting patient safety.
- External Customers and Internal Clients: The recommendations address the needs of both patients and staff, ensuring a safe and healthy environment for all.
- Competitors: The recommendations leverage best practices from other healthcare institutions that have successfully implemented hand hygiene improvement programs.
- Attractiveness: The recommendations are cost-effective and offer a high return on investment by reducing healthcare-associated infections and improving patient outcomes.
Assumptions:
- The hospital leadership is committed to improving hand hygiene compliance.
- Staff members are receptive to behavioral nudges and technology-based interventions.
- The hospital has the resources to implement the recommended interventions.
6. Conclusion
By implementing a multi-pronged approach that combines behavioral nudges, technology and analytics, and employee incentives, Brigham and Women's Hospital can significantly improve hand hygiene compliance among its staff. This will contribute to a safer and healthier environment for patients, staff, and the entire healthcare system.
7. Discussion
Alternatives:
- Mandatory Hand Hygiene Training: While mandatory training is important, it may not be sufficient to change behavior on its own.
- Stricter Enforcement: Implementing stricter penalties for non-compliance may have unintended consequences, such as creating a culture of fear or resentment.
Risks:
- Resistance to Change: Staff may resist changes to their routines or perceive the interventions as intrusive.
- Technological Challenges: Implementing technology solutions may require significant investment and technical expertise.
Key Assumptions:
- The hospital leadership is committed to improving hand hygiene compliance.
- Staff members are receptive to behavioral nudges and technology-based interventions.
- The hospital has the resources to implement the recommended interventions.
8. Next Steps
- Develop a Comprehensive Implementation Plan: Outline the specific interventions, timelines, and responsibilities for each step.
- Pilot Test Interventions: Conduct pilot tests of the interventions in specific departments or units to assess their effectiveness and refine the approach.
- Monitor and Evaluate Progress: Regularly monitor hand hygiene compliance rates and assess the impact of the interventions.
- Communicate with Staff: Communicate the rationale for the interventions and solicit feedback from staff to ensure buy-in and support.
By taking these steps, Brigham and Women's Hospital can effectively implement a hand hygiene improvement program that will lead to sustained improvements in compliance and patient safety.
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