Freakonomics in the Times Magazine: Selling Soap

The September 25, 2006, Freakonomics column in the New York Times Magazine is about one hospital’s crusade to solve a common dilemma: How do you get doctors to wash their hands?

A 1999 report from the Institute of Medicine found that more people die each year from hospital errors than from either motor-vehicle crashes or breast cancer, and that one of the leading errors is the spread of bacterial infections.

Leon Bender, a urologist at Cedars-Sinai Medical Center, felt compelled to help change his colleagues’ behavior. While the safety of patients-and the doctors themselves-would seem to be enough incentive for doctors to wash their hands, a multitude of medical studies have proved that medical personnel wash their hands in fewer than half of the instances they should.

In this article, Dubner and Levitt explore the evolution of an incentive scheme that drastically improved hand-hygiene compliance at one hospital.

Click here to read the article. If you wish to comment on the article or this issue in general, visit the Freakonomics blog here. This blog post supplies additional research material.

1. The spread of infection within hospitals is hardly a new problem. This paper (1847) by Hungarian physician Ignaz Semmelweis was the first to assert the vital necessity of proper hand hygiene.
2. Researchers at the University of Geneva hospital conducted a study, published in 2004, to determine hand-washing compliance among doctors. The results were sobering, especially the finding that doctors were the worst offenders (over nurses and aides).
3. “To Err Is Human,” a 1999 report issued by the Institute of Medicine, argued that a staggering number of preventable deaths are due to hospital errors.
4. The “100,000 Lives Campaign” has made hand hygiene one of its chief initiatives. Its website has a lot of information including research, strategy, and results from hospitals around the country.
5. What finally caused doctors at Cedars-Sinai to wash their hands more frequently? This screen saver was one big reason.
6. Craig Feied, a physician and hospital administrator is looking for creative solutions to the spread of bacteria in hospitals. He is currently working with a technology company to develop hospital surfaces where bacteria cannot thrive.