#40 2006 · Cedars-Sinai Medical Center · Hospital careattack-invisible-cost
Cedars-Sinai got doctors to wash their hands by photographing the bacteria growing on their own palms
the problem
Doctors kept skipping handwashing despite signs and cash rewards
background
Hospital hand-hygiene compliance is a stubborn problem precisely because the people skipping it are trained professionals who already know the textbook reason to wash up — reminders don't fail from ignorance. Cedars-Sinai had already run the standard playbook: posted signage, and a 'Hand Hygiene Safety Posse' that handed out $10 Starbucks gift cards to staff caught washing their hands properly. That lifted compliance from 65% to 80%, a real gain, but still short of where the hospital needed to be.
The hospital's epidemiologist, Rekha Murthy, was looking for something that would land with doctors specifically — a group whose confidence in their own cleanliness was part of the problem.
the move
Murthy asked the hospital's most senior, most respected physicians to press their palms onto culture plates right after lunch, no scrubbing first. The plates grew thick colonies of bacteria; she had the most dramatic result photographed and set as the screensaver on every computer in the hospital, so doctors who trusted their own hands saw, in close-up, exactly what was living on them.
the payoff
Hand-hygiene compliance rose to nearly 100% and stayed there, without further reminders, rewards, or campaigns — the image itself did the work that a decal or a gift card couldn't.
what came after
First reported by Stephen Dubner and Steven Levitt in a 2006 New York Times Magazine column and later retold in *SuperFreakonomics*, the story is now widely cited in hospital-safety and behavioral-design writing as a case for disgust succeeding where signage and small cash incentives plateaued.
filed under
references
- [1]Bob Sutton (Stanford) — "Hand Washing and Evidence-Based Management," citing Dubner & Levitt, "Selling Soap," NYT Magazine, Sept 24 2006Bob Sutton / Work Matters, 2006bobsutton.org
- [2]Vitalacy — The Art of Hand Hygiene: 5 Handwashing Signs That Got Attention at HospitalsVitalacy (Medium), 2017medium.com