Improving Hand Hygiene Process Compliance Through Process Monitoring in Healthcare

Abstract

Problem definition: We study a compliance problem of healthcare workers (HCWs) in hospitals where hand hygiene compliance rates are generally low. We first analyze how peer effects impact compliance decisions of HCWs and then analyze how monitoring can improve compliance. Academic/practical relevance: Inducing process compliance of human operators is an ongoing challenge in operations management with significant implications on the productivity and the quality of the products or services rendered by standardized processes. In healthcare, low hand hygiene compliance of HCWs is the leading cause of hospital-acquired infections, which can be largely prevented by HCWs following standardized hand hygiene processes. Methodology: Using a game-theoretical approach, we model HCWs’ reactions to peers’ (non-)compliance to determine their equilibrium compliance levels. We integrate the model with a disease-transmission model to determine how the compliance affects disease prevalence in a hospital ward. Results: When the process compliance is endogenous, HCWs play a mixed strategy in equilibrium between complying and noncomplying. We establish that a macrolevel hand hygiene compliance rate of HCWs can result from a combination of four different types of microlevel noncompliance: free-riding, safe-playing, self-regarding, and opportunistic behaviors. Finally, we show that the marginal effect of monitoring on reducing disease prevalence depends on clinical factors, HCWs’ interpersonal learning, and other integration factors like goal setting. Managerial implications: The results demonstrate that the monitoring intervention may not effectively prevent disease transmission without understanding the microlevel behaviors of noncompliant HCWs. Our results provide an explanation as to why there is a significant variability in the effectiveness of management intervention as observed in practice.