Our brains and infection control: Carrots work better than sticks?

One of the banes of infection prevention is poor compliance with best practice. Hand hygiene compliance is but one example. The way we attempt to improve compliance at our hospital is constant monitoring of compliance and feedback to specific poorly compliant individuals to try to get them to improve. We have anonymous tip lines and individuals reported into the system get a quick call or visit from our CMO or me. Thus, we have more of a stick approach than a carrot. Does this approach work? I would say there is always room for improvement.

So, there must be another way. A recent article in Harvard Business Review suggests that our brains actually respond to carrots and not to sticks. Discussing work done at MIT by Earl Miller, the article tells how our brains re-wire after rewards and actually work more efficiently towards the rewarded activity but nothing happens after failure. They do clarify that learning does occur after punishment that is severe (a shock) but in QI this would likely occur only if the offender was fired or had a paycheck withheld. Perhaps our hand hygiene dispensers should put forth a few bars of Beethoven's Ninth after each successful use?