Wednesday, February 9, 2011

Starbucks and nosocomial infection

What does Starbucks have to do with nosocomial infection? Well if you read the second Freakonomics book, perhaps not surprisingly entitled 'Superfreakonomics', you'll have recognized part of today's lecture. The author's, economists Steven D. Levitt and Stephen J. Dubner, narrate the same story from Semmelweis's amazing conclusion to today's problem of poor handwashing compliance in hospitals. However because they are economists their main interest is in how this problem is best addressed - by punishing doctors who fail to wash their hands, by education and regular reminders, or by rewarding doctors who do.

Levitt and Dunbar cite a study at Cedar-Sinai hospital where they had identified low compliance with hand washing protocols as a problem. Initially the hospital tried gently cajoled the doctors with e-mail, faxes and posters. But that didn't work. They knew this because the  hospital had enlisted a crew of nurses to surreptitiously report on the doctor’s hand-washing.

They then started a Hand Hygiene Safety Posse that roamed the wards but rather than searching for doctors who weren’t compliant, they’d try to “catch” a doctor who was washing up, giving him a $10 Starbucks card as reward. You might think that the highest earners in a hospital wouldn’t much care about a $10 incentive but this simple startegy was very effective and compliance rose to about 80 percent as doctors competed for Starbucks cards! By utilising the screen saver I showed in class as a continual reminder to doctors they were able to raise it even further - apparently close to 100%

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