Motivating Process Compliance through Individual Electronic Monitoring: An Empirical Examination of Hand Hygiene in Healthcare

Management Science, Vol. 63(5), p. 1563 – 1585, May 2017

46 Pages Posted: 9 May 2017 Last revised: 1 May 2019

See all articles by Bradley R. Staats

Bradley R. Staats

University of North Carolina Kenan-Flagler Business School

Hengchen Dai

University of California, Los Angeles (UCLA) - Anderson School of Management

David A. Hofmann

University of North Carolina Kenan-Flagler Business School

Katherine L. Milkman

University of Pennsylvania - The Wharton School

Date Written: October 28, 2015

Abstract

The design and use of standard processes are foundational recommendations in many operations practices. Yet, given the demonstrated performance benefits of standardized processes, it is surprising that they are often not followed consistently. One way to ensure greater compliance is by electronically monitoring the activities of individuals, although such aggressive monitoring poses the risk of inducing backlash. In the setting of hand hygiene in healthcare – a context where compliance with standard processes is frequently less than 50% and where this lack of compliance can result in negative consequences – we investigated the effectiveness of electronic monitoring. We did so using a unique, RFID-based system deployed in 71 hospital units. We found that electronically monitoring individual compliance resulted in a large, positive increase in compliance. We also found that there was substantial variability in the effect across units and that units with higher levels of pre-activation compliance experienced increased benefits from monitoring relative to units with lower levels of pre-activation compliance. By observing compliance rates over three-and-a-half years, we investigated the persistent effects of individual monitoring and found that compliance rates initially increased before they gradually declined. Additionally, in multiple units, individual monitoring was discontinued, allowing for an investigation of the impact of removing the intervention on compliance. Surprisingly, we found that after removal, compliance rates declined to below pre-activation levels. Our findings suggest that although individual electronic monitoring can dramatically improve process compliance, it requires sustained managerial commitment.

Keywords: Process Compliance, Hand Washing, Electronic Monitoring, Empirical Operations

Suggested Citation

Staats, Bradley R. and Dai, Hengchen and Hofmann, David A. and Milkman, Katherine L., Motivating Process Compliance through Individual Electronic Monitoring: An Empirical Examination of Hand Hygiene in Healthcare (October 28, 2015). Management Science, Vol. 63(5), p. 1563 – 1585, May 2017. Available at SSRN: https://ssrn.com/abstract=2964542 or http://dx.doi.org/10.2139/ssrn.2964542

Bradley R. Staats

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

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

Hengchen Dai (Contact Author)

University of California, Los Angeles (UCLA) - Anderson School of Management ( email )

110 Westwood Plaza
Los Angeles, CA 90095-1481
United States

David A. Hofmann

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

United States

Katherine L. Milkman

University of Pennsylvania - The Wharton School ( email )

Philadelphia, PA 19104
United States

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