Thursday, 2 April 2015
Now Wash Your Hands
Here's an extract from the book as a teaser:
Creative thinking has taken on a kind of mythic quality in recent decades that, frankly, it doesn’t deserve. Or, more accurately, that it doesn’t deserve any more than any other kind of thinking. You’ll find ‘creative thinking’ lurking somewhere near ‘problem solving’ in almost any corporate blurb you care to read and, based on a trawl of the internet, it seems that nearly all problem solving training courses are essentially creative thinking courses. If we’re to believe the hype, you can’t solve problems without it. However, it’s been my experience that many problems can be solved with almost no creative thinking involved at all.
Take Hospital Acquired Infections (HAIs) as a good example. These account for a large number of deaths – 99,000 per year in the USA alone (making it the fourth most common cause of death nationally) even though 30-50% of HAIs are entirely preventable and may be eliminated by simply enforcing tougher hygiene regimes. The Mayo Clinic recently published the results of a study in which it showed that ‘consistent daily cleaning of all high-touch surfaces with a spore-killing bleach disinfectant wipe’ had substantially reduced the incidence of superbug Clostridium difficile infection at a hospital in Minnesota. ‘The goal was to reduce hospital-acquired C. difficile infection rates in two of our highest-incidence units by 30%,’ explained lead investigator Robert Orenstein. ‘Our data show we far exceeded that. When the study concluded, one unit had gone 137 days without a hospital-acquired C. difficile infection’. There’s no creative thinking needed here – just discipline and maybe a Soupçon of understanding about what motivates people.
I've posted that extract today as I've been reading a fair bit about hand hygiene and the various ways that people are tackling the issue of superbugs. It's clear that good handwashing regimes are hugely effective - but how do you get people to change their ways? Some digging around has found some interesting examples of problem solving:
Hand hygiene improved 100% at Cedars-Sinai Medical Center after the hospital started using pictures of the bacteria found on the palm prints of medical staff as screensavers.
A more subtle approach could be using a lemon scent in the air. The association with cleanliness is so strong that it can encourage a 10-15% increase in hand washing.
Copper door handles work brilliantly as copper is antimicrobial. Scientists are actively looking into employing a range of copper alloy 'touch surfaces' such as light switches, fridge door handles, bed armrests etc. to destroy a wide range of microorganisms that threaten public health.
But if shaming is your thing, you can also buy an inexpensive kit from makezine.com that uses sensors to detect when the toilet is used, then when the sink is used, and, lastly, when the toilet door is opened. If someone uses the loo but doesn’t use the sink, a microcontroller sounds an alarm when they open the door to leave. It might also light up a ‘Did not wash hands!’ sign if you’re feeling especially cruel.
Image copyright (c) Gary Larson
Professor Adam Grant of Wharton University and Professor David Hofmann from the University of North Carolina have been doing some research into what kind of 'nudges' medical professionals respond to best. They conducted a series of behaviour tests in a US hospital and the results are very interesting.
They posted signs next to 66 of the hospital's soap and hand-sanitiser dispensers for two weeks. One third of those signs appealed to health care professionals' self interest:
HAND HYGIENE PREVENTS YOU FROM CATCHING DISEASES.
One third emphasised the consequences for patients, that is, the purpose of the hospital's work:
HAND HYGIENE PREVENTS PATIENTS FROM CATCHING DISEASES.
The final one third of the signs included a snappy slogan and served as the control condition:
GEL IN, WASH OUT.
When they tabulated the results, they found that the most effective sign, by far, was the second one. The amount of hand hygiene product used from dispensers with the patient consequences signs was significantly greater than the amount used from dispensers with the personal consequences sign or the control sign.
Intrigued by the results, the researchers decided to test the robustness of their findings nine months later in different units of the same hospital. This time they used only two signs - the personal consequences and the patient consequences signs. They also recruited hospital personnel to be their hand washing spies, covertly recording when doctors, nurses and other healthcare staff faced a hand hygiene opportunity and how they responded. Once again, the personal consequences sign had zero effect, but the sign appealing to purpose boosted hand washing by 10 percent overall and significantly more for the physicians.
Clever signs alone won't eliminate hospital acquired infections. As surgeon Atul Gawande has observed, checklists and other processes can be highly effective on this front. But Grant and Hoffman reveal something equally crucial: 'Our findings suggest that health and safety messages should focus not on the self, but rather on the target group that is perceived as most vulnerable.'
While we often assume that human beings are motivated mainly by self-interest, a stack of research has shown that all of us also do things for what social scientists call pro-social or self-transcending reasons. That means that not only should we ourselves be serving, but we should also be tapping others' innate desire to serve. Making it personal works better when we also make it purposeful.
Gorman, J. (2012) ‘Survival’s Ick Factor’. New York Times, January 23d 2012
Iyer, P., Sara, J., Curtis, V., Scott. B. & Cardosi, J. (2002) The Handwashing Handbook. World Bank Group in association with Unicef et al
Jansen, I. & Murphy, J. (2009) 'Environmental cleaning and healthcare – Associated infections'. Healthcare papers, Volume 9, No. 3. Longwoods Publishing
Kerr, K. L., Rosero, S. J. & Doty, R. L. (2005) ‘Odors and the perception of hygiene’. Perceptual and Motor Skills February 2005 Vol. 100(1):135-41.
Laitala, K., Boks, C., & Klepp, I. G. (2011) ‘Potential for environmental improvements in laundering’. International Journal of Consumer Studies 35:10.1111/ijc.2011.35.issue-2, 254-264.
‘Mayo Research: Intervention drops hospital infection rate by a third’. 19th March 2010. www.mayoclinic.org
Thurman R.B., Gerba C.P. (1989). 'The Molecular Mechanisms of Copper and Silver Ion Disinfection of Bacteria and Viruses'. CRC Critical Reviews in Environmental Control 18 (4): 295–315.