#77 2006 · Cedars-Sinai Medical Center · Hospital care
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.
what everyone would do
The standard playbook was reminders and incentives: signage, posters, and cash rewards for staff caught washing their hands. That lifted compliance from 65% to 80% but plateaued, because doctors already knew the textbook reason to wash their hands — the problem wasn't information they lacked, it was a belief they already held: that their own hands were clean. No sign or gift card argues with that belief; it just adds noise around it.
what they saw
Murthy saw that the doctors skipping handwashing weren't ignorant of the risk in the abstract — they simply didn't believe the risk applied to THEM specifically. A generic statistic about hospital-acquired infections lets every doctor assume it describes someone else's carelessness. The fix wasn't more information about hand hygiene in general; it was making the invisible bacterial load on that specific doctor's own hands undeniably, personally visible.
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.
why it works
Culturing the hands of the hospital's most senior, most confident physicians and photographing the result converts an abstract statistic ('doctors under-wash their hands') into a concrete, personal fact ('this is what is growing on MY hands right now') that a doctor cannot rationalize away as describing someone less careful than himself. Setting the image as the default screensaver puts that evidence in front of every doctor, repeatedly, without requiring anyone to seek it out or be lectured — the confrontation happens passively, every time a computer wakes up, which is why it needed no ongoing campaign to sustain the effect. Because disgust and personal identification are far stronger motivators than statistical risk, the same behavior change that reminders and gift cards had only partially achieved arrived almost immediately once the belief being challenged — 'my hands are clean' — was directly and visibly contradicted.
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.
where it breaks
The mechanism depends on the audience's resistance being a false belief about themselves specifically, not a lack of information, capacity, or resources — showing someone evidence of a problem they already know they have (and can't afford to fix) does nothing but demoralize. It also requires the evidence to be inescapable and personally attributable; a generic or anonymized version of the same photo lets the same rationalization creep back in ('that's someone else's hands'), which is why using the most respected physicians' own cultures specifically was likely load-bearing. And repeated exposure can desensitize — an image that shocks the first hundred times may fade into wallpaper eventually, so the mechanism's durability past the point of novelty is less proven than its initial jolt.
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.
references
- [1]Freakonomics in the Times Magazine: Selling SoapFreakonomics (Dubner & Levitt, on their original NYT Magazine column), 2006freakonomics.com
- [2]Hand Washing Rate Low Among DoctorsABC News, 2009abcnews.go.com