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, radio frequency identification (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 preactivation compliance experienced increased benefits from monitoring relative to units with lower levels of prepreactivation 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 prepreactivation levels. Our findings suggest that, although individual electronic monitoring can dramatically improve process compliance, it requires sustained managerial commitment.
AcknowledgmentsWe are grateful to many individuals at Proventix, including David Sellers, Harvey Nix, and Elizabeth Pembleton, whose assistance made this project possible. We thank Christian Terwiesch for his helpful comments as we developed the manuscript. We acknowledge the developmental assistance of the DE, AE, and reviewers in improving this paper throughout the review process. Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number P30AG034532. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Any errors are the responsibility of the authors.
COMPLIANCE AND MONITORING 1
AbstractThe 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 st...