Hand-hygiene Rates Improved Through Variety of Reinforcement Styles

Again, the introduction of the cards showed an increase in compliance—but again, not enough of a jump to be completely satisfied.

"We saw an increase that year. We made it to 90% one month, but for year to date we were at 86%," said Dougherty.

The next step toward improvement: posting names.

"We continued the positive rewards program, but … we started reporting both those who did well, and those who needed to improve," says Dougherty.

The good with the bad

There was a great deal of deliberation within the leadership team on this concept. Leaders made a conscious decision to hold everyone accountable while continuing to "use the carrot instead of the stick," staying with positive reinforcement to motivate employees to higher hand-hygiene compliance.

So, to temper the negative reinforcement of posting names—which helped improve compliance as well—BJSPH added an additional, and very public, way of rewarding those who were spotted using proper hand-hygiene processes. /p>

"Any [month] we meet or exceed our goal, we will take the names of everyone who was recognized as doing a good job, put their names into a drawing, and have a 'hand hygiene hero' drawn in the cafeteria," says Dougherty.

The cafeteria is shared by staff and guests alike, so the congratulatory ceremony—including Bonnie Tyler's 1980s hit "Holding Out for a Hero" playing loud and clear—can be witnessed not only by staff, but also the people using the hospital and their visitors. There's a gift involved for the winner of the drawing as well (a $25 gift certificate) and, in months where the goal is exceeded, multiple names are drawn.

Winners' pictures are taken and posted throughout the building—even built into screen savers on hospital computers. The tactic has been well-received by the staff, and when a winner is present in the cafeteria during the drawing, cheers have been known to break out.