MOTIVATING PROCESS COMPLIANCE THROUGH INDIVIDUAL ELECTRONIC MONITORING: AN EMPIRICAL EXAMINATION OF HAND HYGIENE IN HEALTHCARE
Method: We relied on data from a company that uses a radio frequency identification-based system to monitor healthcare workers’ hand hygiene compliance in hospitals. We observed over three-and-a-half years of compliance data from caregivers in 71 hospital units at 42 hospitals where electronic monitoring was deployed (encompassing over 20 million observations of hand hygiene opportunities). Since 71 hospital units activated electronic monitoring over the course of three years, this staggered roll-out allows us to isolate the effects of activating electronic monitoring on hand hygiene compliance from the effects of other potentially confounding factors, such as general time trends in hand hygiene compliance or the roll-out of a public campaign. The large number of hospital units involved in this study allows us to examine whether and why there is variability in the monitoring effect across hospital units. Also, the three-year longitudinal panel data allow us to explore whether the initial effects of activating electronic monitoring are strengthened over time or instead decay. For nine hospital units, electronic monitoring was discontinued, allowing us to evaluate the effects of the removal of monitoring on hand hygiene compliance. We used ordinary least squares (OLS) regressions to analyze our data.
Result: We find that, on average, caregivers exhibited a large and significant increase in hand hygiene compliance after electronic monitoring was activated. There is significant variability in the monitoring effect across units and that units with stronger social norms for hand hygiene compliance experienced bigger benefits from monitoring than units with weaker norms. Further, the benefits of monitoring increased for nearly two years before they eventually gradually degraded. Surprisingly, after monitoring was terminated, hand hygiene compliance did not sustain but dropped even below pre-monitoring levels.
Conclusion: Our findings highlight the need for not only implementing electronic monitoring, but also continuing to actively manage compliance efforts. The termination effect observed in our study highlights the limitations of merely monitoring desired behavior as a means of producing lasting compliance.