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Direct Observation Is Now The “Fool’s Gold” Standard

The days of secret shoppers hiding in a corner with a clipboard are over. Our system monitors over 4,000 hand hygiene opportunities per bed per month on average. Direct observation is lucky to capture a fraction of a percent of that. In addition, the Hawthorne Effect1 shows that hand hygiene rates triple when a clinician knows they’re being watched. And at least a dozen other human biases taint findings, ranging from confirmation bias and observer drift to uniform application errors and the inability to see into patient rooms. (Read more in “Direct Observation: the ‘Fool’s Gold’ Standard.”)

Not only is data from direct observation grossly inaccurate, it does little to actually change behavior. (Read more in “The Impossible Duality of Direct Observation.”) Using technology to accurately capture virtually every opportunity – and then improve performance in the moment – is much more effective.


  1. Srigley, J.A., et al., Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study. BMJ Qual Saf, 2014. 23(12): p. 974-80.

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