Acting Like Big Brother Won’t Help Hospitals

Hospital infection rates are higher than they should be because many hospital workers don’t wash their hands as often as they should. That is well-established, and many hospitals involved in improvement efforts are focusing on improving the rate of hand-washing.

More than a year ago, I discussed the issue of just how you get people to wash more often. I cited a blog post by Mark Graban, which included suggestions by author David Mann. Mann made the point that processes can be set up to change behavior, with approaches that include better education of employees, visual controls to instruct people and a process for allowing people to anonymously report offenders.

But not everyone understands that. I was disturbed by a recent posting on The Wall Street Journal Health Blog about a company called Arrowsight. The firm is marketing a service to hospitals specifically designed to improve hand-washing rates, which it says “has worked in food processing and manufacturing plants.” The service: video surveillance.

In an earlier pilot, launched in January of 2007, the company says its hospital video auditing service boosted hand-hygiene compliance to 90% from 38% in three months. The improvement was durable, remaining above 90% for twelve months running…

While live auditors won’t be monitoring worker’s every move 24/7, the Arrowsight system is programmed to search huge volumes of video very efficiently. It’s smart enough to catch such triggers as a door opening to a hospital room to capture whether staffers washes their hands after entering.

If the compliance rate remained high for 12 months, that is only because employees know they are still being watched.

More importantly, video monitoring flies in the face of the lean principle of respect for people. It can only make workers suspicious and resentful, and hurt morale. And it certainly does not encourage anyone to be a creative, thinking employee who contributes improvement ideas.

I hope hospitals will resist this approach.