Negative Externalities: The Unexpected Economics of Hand Washing
Sometimes economics can involve a lot more than money. My local hospital is engaged in a hand washing campaign. The problem is that physicians ignore the mandate, even more than nurses and other hospital personnel. Yes, a doctor is busy and a sink might not be nearby but studies show that even when hygiene is available, compliance is inadequate. The economic problem? We have a negative externality. The doctor does not suffer. The parties from whom he acquired the bacteria on his hands were not affected. Instead, as with all negative externalities, uninvolved bystanders are experiencing the cost of the physicians’ behavior. The economic solution: We have to increase the “cost” (defined economically as sacrifice) of the behavior.
- At one LA hospital, it simply was a computer screen-saver on all hospital computers with petri dish pictures of bacteria cultures taken from physicians’ hands. The pictures were described as sufficiently disgusting that many more doctors complied.
- A second solution at the LA hospital was to publicly identify non-washers during departmental meetings.
- Elsewhere, a sign that read, “Hand Hygiene Prevents Patients from Catching Diseases” increased hand washing.
With all 3 approaches, the “cost” of non-compliance went up. People tend to do less of something when the cost is higher. What did not work? When a hand washing “posse” randomly gave $10 Starbucks cards to doctors “caught” washing, they willingly accepted the reward but the impact was insufficient. Signs and emails, Purell hand disinfectant everywhere…little success. Still though, getting people to wash their hands is only half of the hygiene problem. More tomorrow on why drying our hands also matters. Sources and Resources: Freakonomics had a wonderful podcast on the hand washing problem, they also wrote about it here, and this NY Times article provides more details about relevant academic studies. In addition, I recommend this superb New Yorker article from Atul Gawande on using checklists in hospitals to minimize mistakes. A Hand Washing Flash Mob Note: The Title of this post was slightly edited.