The Impact of Time at Work and Time off from Work on Rule Compliance: The Case of Hand Hygiene in Healthcare

52 Pages Posted: 8 Sep 2013 Last revised: 7 May 2017

Hengchen Dai

Washington University in St. Louis - John M. Olin Business School

Katherine L. Milkman

University of Pennsylvania - The Wharton School

David A. Hofmann

University of North Carolina Kenan-Flagler Business School

Bradley R. Staats

University of North Carolina Kenan-Flagler Business School

Date Written: September 3, 2013

Abstract

In order to deliver high quality, reliable, and consistent services safely, organizations develop professional standards. Despite the communication and reinforcement of these standards, they are often not followed consistently. Although previous research suggests that high job demands are associated with declines in compliance over lengthy intervals, we hypothesized – drawing on theoretical arguments focused on fatigue and depletion – that the impact of job demands on routine compliance with professional standards might accumulate much more quickly. To test this hypothesis, we studied a problem that represents one of the most significant compliance challenges in healthcare today: hand hygiene. Using longitudinal field observations of over 4,157 caregivers working in 35 different hospitals and experiencing more than 13.7 million hand hygiene opportunities, we found that hand hygiene compliance rates dropped by a regression-estimated 8.5 percentage points on average from the beginning to the end of a typical, 12-hour work shift. This decline in compliance was magnified by increased work intensity. Further, longer breaks between work shifts increased subsequent compliance rates, and such benefits were greater for individuals when they had ended their preceding shift with a lower compliance rate. In addition, (a) the decline in compliance over the course of a work shift and (b) the improvement in compliance following a longer break increased as the caregiver accumulated more total work hours the preceding week. The implications of these findings for patient safety and job design are discussed.

Keywords: workplace compliance, job demands, fatigue, work recovery, job design

Suggested Citation

Dai, Hengchen and Milkman, Katherine L. and Hofmann, David A. and Staats, Bradley R., The Impact of Time at Work and Time off from Work on Rule Compliance: The Case of Hand Hygiene in Healthcare (September 3, 2013). The Wharton School Research Paper No. 56; UNC Kenan-Flagler Research Paper No. 2320114. Available at SSRN: https://ssrn.com/abstract=2320114 or http://dx.doi.org/10.2139/ssrn.2320114

Hengchen Dai (Contact Author)

Washington University in St. Louis - John M. Olin Business School ( email )

One Brookings Drive
Campus Box 1133
St. Louis, MO 63130-4899
United States

Katherine L. Milkman

University of Pennsylvania - The Wharton School ( email )

Philadelphia, PA 19104
United States

David A. Hofmann

University of North Carolina Kenan-Flagler Business School ( email )

United States

Bradley R. Staats

University of North Carolina Kenan-Flagler Business School ( email )

McColl Building, CB#3490
Chapel Hill, NC 27599
United States

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