Leverage the Hawthorne Effect in Your Favor

By Chris Hermann

The Hawthorne Effect is a well-established principle that explains why people change what they do when they know their behavior is being measured. Simply put, the attention from researchers and observers impacts the results that they’re trying to measure. In the hand hygiene space, the Hawthorne Effect refers to clinicians being more likely to clean their hands when they know a not-so-secret shopper is observing them.

A recent study in Australia[1] demonstrates that the Hawthorne Effect is alive and well. The study used technology to measure hand hygiene performance at a large teaching hospital. In addition, human auditors observed hand hygiene behavior for 20 minutes per day on selected wards.

Results? Direct observation recorded a 94% hand hygiene performance rate during the 20 minutes of daily surveillance. However, technology recorded a 30% rate during non-observed periods of time.

This tripling of hand hygiene is consistent with earlier studies performed by Srigley, et al.[2] and Hagel, et al.[3] When healthcare providers know someone is watching them, they are three times as likely to clean their hands.

This situation puts both patients and the hospital at risk. Hospitals are given a false sense of complacency with numbers that are inflated by the direct observer being present. As soon as the observer walks away, patients are then at risk when hand hygiene immediately returns to the real level.

What can be done?

Ideally, use technology to gather accurate hand hygiene data. But don’t stop there (which the Australian hospital did). Use automation to remind clinicians in the moment when they forget to clean their hands. This is much more consistent and scalable than relying on human observers.

If this can’t be done, leverage the Hawthorne Effect by using human observers in high risk situations. When there’s a patient at risk of either catching or transmitting an infection, this is the best place for observers to visibly surveil providers. Our Real-Time Intervention Blueprints™ show, at a glance, which rooms have low hand hygiene performance. It even differentiates between isolation and C. diff rooms, so unit managers can ensure that the highest risk rooms have appropriate hand hygiene. If not, this is the time and place to send observers so they can change behavior and nip any problems in the bud.

If you’d like to explore how our system typically doubles or triples hand hygiene performance rates and reduces HAIs by up to 75-80%, here’s a brief video about how it works. Or here’s a white paper on How the New Joint Commission Hand Hygiene Standards Could Impact Your Hospital.


[1] McLaws, M. and Kwok, Y. (2018). Hand hygiene compliance rates: Fact or fiction?. American Journal of Infection Control. [online] Available at: https://www.ajicjournal.org/article/S0196-6553(18)30427-9/fulltext [Published 17 May 2018].

[2] 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.

[3] Hagel, S., et al., Quantifying the Hawthorne Effect in Hand Hygiene Compliance Through Comparing Direct Observation With Automated Hand Hygiene Monitoring. Infect Control Hosp Epidemiol, 2015. 36(8): p. 957-62.



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