Using the Nudge Theory in Hand Hygiene Compliance Efforts

The Nudge Theory has been widely used to improve healthy behavior and works as an external cue to memory. Kwok and McLaws (2015) report on their efforts to engage medical staff in improved hand hygiene compliance. 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 hand-over meetings and to use a seven-step approach that included nudging each other on the wards with “Doctor, take a moment.” The researchers compared feedback from clinicians about nudging and rates on both wards from June 2014 to February 2015.

During the run-in period prior to introducing nudging, the baseline compliance rate was 18 percent on ward C and 37 percent on ward D. Preliminary results indicated one ward has improved by 32 percentage points while compliance on ward C remained stable at 15 percent. Clinicians on ward D reported that they were comfortable working as a team to nudge each other toward 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.

The researchers concluded that 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.

Reference: Kwok A and McLaws ML. Oral presentation: How to get doctors to hand hygiene: nudge nudge. Antimicrobial Resistance and Infection Control: Abstracts from the 3rd International Conference on Prevention and Infection Control (ICPIC 2015). Antimicrobial Resistance and Infection Control 2015, 4(Suppl 1):O51  doi:10.1186/2047-2994-4-S1-O51

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