How To Build A Culture Of Accountability Around Hand Hygiene

Updated: Oct 31, 2018

It goes without saying that hand washing is a crucial part of infection control in hospitals. But even though this is a universally accepted fact, it’s still an issue that hospitals struggle with.

Getting handwashing compliance rates up to par is often more than just a matter of infection control. In fact, it’s actually part of a larger need to create and sustain a culture of accountability within healthcare organizations.

Here’s how you can build a culture of accountability in your healthcare organization.

What “Accountability” Really Means

One of the problems organizations—including hospitals—face when trying to create a culture of accountability is that the word “accountability” can carry a negative stigma.

Instead of being associated with an incentive to achieve goals, accountability is often linked to punishments for a failure to accomplish the tasks at hand, notes the US Office of Personnel Management (OPM).

Switching this view of accountability from negative and punitive to positive and rewarding can make all the difference in boosting handwashing compliance rates.

For example, Vanderbilt University Medical Center (VUMC) saw an improvement in hand hygiene when it began providing a financial incentive for compliance. Self-insured for malpractice claims, the center included hand hygiene compliance as one of its goals in a self-insurance trust rebate program.

Departments and units that achieved compliance goals could receive a rebate of up to 2.5% of malpractice premiums. This incentive was an integral part of VUMC’s success, helping increase compliance from 52% to over 85% in less than 2 years.

At Texas Children’s Hospital, hand hygiene was integrated into the employee bonus program. However, the program didn’t stop there—the hospital’s infection control specialists convinced the administrators that they couldn’t hold employees responsible for hand hygiene if they were not responsible as well.

In order to receive the hand hygiene portion of the bonus, the entire facility—employees and administrators—had to meet a 95% compliance goal. Since implementation, compliance rates have remained between 95 and 99%.

How One Hospital Got Creative—And Brought A Culture Of Accountability To Their Organization

As a September 2006 New York Times article explains, linking accountability to rewards can also mean educating your staff in a creative way. This was the case several years ago at Cedars-Sinai Medical Center when handwashing was the target of a campaign to increase compliance rates ahead of a Joint Commission review.

Initially, incentives—such as $10 Starbucks gift cards—for providers who were “caught in the act” of practicing good hand hygiene brought the compliance rate up from 65 to 80%. But this rate was still 10% short of the Joint Commission’s 90% compliance goal.

Then, an ingenious move by Cedars-Sinai’s epidemiologist Rekha Murthy, MD, helped the hospital surpass the Joint Commission’s goal and bring the compliance rate to nearly 100%.

Dr. Murthy asked the attendees at a meeting of the Chief of Staff Advisory Committee—many of whom were doctors—to allow her to culture their hands. They complied, and she created images of the cultures.

The resulting germ-laden images were so compellingly “gross” that one of them was applied as a screensaver on all of the computers in the hospital.

According to the New York Times article, the startling visual reminder of the dangers that lie unseen on unwashed hands was enough to get the message across—and boost hand hygiene compliance throughout Cedars-Sinai.

Building A Culture Of Accountability In Your Healthcare Organization

As the Cedars-Sinai story also illustrates, building a culture of accountability starts at the top, with the organization’s leadership.

These last two points reiterate the OPM’s emphasis on refocusing the connotation of the word accountability from a negative term to a positive term.

And, in a sense, this is exactly what Dr. Murthy and other members of the leadership team at Cedars-Sinai did:

  • The goal was clearly defined: a 90% handwashing compliance rate.

  • Hand sanitizer was made readily available—including in the employee parking lot.

  • Employees who were found to be in compliance received recognition in the form of Starbucks gift cards.

  • The reasons for the expectations were communicated in the form of the germ-cultured hand screensaver image.

While every hospital’s situation is unique—meaning a solution that works for one organization might not be a perfect fit for another—the principles of accountability are the same. And so is the goal in the case of handwashing compliance: infection control through hand hygiene.

Let’s talk about how we can help your healthcare facility meet your hand hygiene goals this year. Contact us at (310) 745-5050 or

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