Blame them, shame them, and fire them! Or give them bonuses. Or something.

In part two of the NY Times “Fixes” blog piece on hand hygiene, Tina Rosenberg tackles the perplexing challenge of improving hand hygiene practices in hospitals. An excerpt from the summary paragraph:

“Health care workers have difficult jobs, and it is important for hospitals to take their views into account when they institute measures to improve hand-washing rates. But if it takes public posting of hand-washing rates and firing of individual doctors or nurses who don’t comply to bring down infection rates, it should be done.”

We covered this ground before, the proper role of reward versus punishment for influencing health care worker behavior. I would love comments from our readers on this. I’ll merely remind everyone that direct observation of “entry-exit” hand hygiene adherence, even in centers that do the most intensive monitoring, captures only a tiny fraction of HH opportunities. And entry-exit adherence is the tip of the iceberg. Try working an 8-hour shift as an ICU nurse while adhering perfectly to all “5 moments”.