Peer Pressure Beats Incentives in Driving Doctor Behavior


You know one of your biggest day-to-day challenges is how to help surgeons, staff and administration to make choices that result in the best clinical and business outcomes. It is frustrating to watch people make the same poor choices over and over. Hand hygiene is a particularly frustrating area as everyone should know intuitively that frequent and proper hand washing is essential. Yet problems persist.

A recent Harvard Business Review article sought to answer the key question when it comes to changing behavior on hand washing - which is a better motivator, cash incentives or peer pressure. that answers that question. What did they find? Peer pressure is a more effective motivator than a cash incentive.

Are you surprised? We know peer pressure affects decision making, but more than monetary bonuses? Really, how can that be?

The study looked at hand hygiene data collected from a California hospital. Management at that hospital came up with an idea. They offered to pay employees a one-time bonus of $1,200 if they were able to improve their hand hygiene methods over a 90-day period. Secret monitors would observe their hand washing techniques and report any violations. If the hospital met their goals, each staff member would receive a check. Well, almost everyone.

In California, doctors can't be hospital employees, so they weren't eligible to receive the $1,200 bonus. They couldn't receive the money, but everyone they worked with could. The doctors' assistants, nurses, techs, and hospital staff used peer pressure, not money, to convince them to follow the rules, and it worked!

The chief nursing officer sent doctors "love letters" thanking them for demonstrating proper hand washing techniques. If they failed to follow the rules, she would send them firm, but respectful emails, asking them to contribute to the hospital's overall goal. Over time, fewer and fewer doctors broke the rules. Not only that, but these doctors continued to follow these procedures after the contest. The doctors' learned behaviors outlasted those of their colleagues, the people who received the cash bonus.

So, what's the key takeaway? In running the OR, you want to encourage people to wash their hands appropriately, just as you want to inspire them to be on time, schedule cases in block time, and participate in time out. You need surgeons and your staff to make the right choices in these areas. Most OR directors don't have access to cash for incentives anyway, so knowing peer pressure works better is a bonus.

Have you used either peer pressure or incentives to change behavior? Let us know.