More Evidence for the Observer Effect in Hospitals, But Does It Apply to the OR?


When employees in a hospital are being monitored, patient outcomes rise, but in an OR setting, turnaround times — one marker of consistency and patient safety — don’t improve from observation alone. The “Hawthorne effect,” is when individuals, typically research subjects, actively change their behavior when they know they are being observed and monitored. This effect has been found effective from everything to hand washing among health care workers to increased voter turnout when voter preferences are being assessed.

In a recent study, published in JAMA Internal Medicine, researchers uncovered a unique form of the Hawthorne effect in hospitals, with important consequences for patients. The study obtained Joint Commission inspection dates for 1,984 U.S. hospitals during 2008-2012 and matched those dates to hospitalization data for more than 1.7 million Medicare beneficiaries. They compared the outcomes of patients admitted to the hospital during an inspection week against patients admitted to the same hospital in the weeks immediately preceding or following the inspection. They found that Medicare patients who were admitted to the hospital during a Joint Commission visit had slightly lower mortality than patients admitted during our non-inspection weeks — especially in large teaching hospitals.

However, the observer effect in operating rooms does not yield the same analysis for patients.  In a study of lean management in academic surgery, there was no significant difference between the baseline and observer-effect periods of the study in either turnover or turnaround time in operating rooms. In a response letter to a reader, one of the study’s researcher gives this explanation: observation and self-analysis are regular features in the operating room culture, and that operating room workers are unaffected by observers because of the highly skilled and precise work performed. Showing workers how to do things effectively and efficiently with lean management tools is far more important than just observing what they do in operating rooms.

What are some systemic issues in your OR that may benefit from lean thinking? Are there times where observer effect has resulted in more effective surgical outcomes? Share with us your thoughts.