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Researchers Say RFID-Related Process Improvements Require Managerial Commitment

A three-university study finds that RFID-enabled hand-washing technology boosted hygiene compliance at hospitals by an average of 20 percent, but without sustained managerial support, those gains disappeared.
By Claire Swedberg

The researchers did not visit the actual hospital sites. Instead, they analyzed data that Proventix had collected from its customers and provided to them. The team found that total hand-hygiene dispenser usage within each unit increased immediately when the system was taken live, compared with compliance rates observed for at least 27 days prior to the systems' activation. The study determined that daily compliance rates averaged about 40 percent before the technology was installed, rising up to about 55 percent before flattening out or dropping several percentage points.

According to the study, the use of RFID-based monitoring may increase compliance due to the development of habitual hand-washing behavior. However, the researchers found, if the monitoring technology was then discontinued, even though workers should have formed a habit of washing their hands, compliance rates instead began to drop, even below previous rates. That could result from a perception that management commitment was gone. The researchers also compared health-care workers' internal versus external motivations, and speculated that employees who already adhered to hand-hygiene practices due to internal motivations (the desire to provide patients with high-quality service) might have shifted their motivation to an external process when an RFID system began tracking when they failed to wash her hands. If that external motivator (such as the RFID system) was then discontinued, staff members might not immediately return to their internally motivated compliance expectations.

Bradley Staats
The success of a real-time location system (RTLS) for monitoring hand-hygiene compliance, then, may have been the result of how the hospital managed that RTLS solution, the study found. Proventix recommends that after a hospital first installs the nGage system, it should gather baseline data for a period of time during which the technology simply tracks the hand-washing dispensers' usage rates. Then, the facilities can begin with interventions that include performance feedback (providing information to caregivers regarding their compliance rates), goal-setting, competition, leadership and incentives.

The study covered a span of time from February 2010 to August 2013. During that period, 12 of the units at nine hospitals discontinued their usage of the RFID systems—typically after a year, when budgets tended to run out. Some hospitals that discontinued the technology, however, continued to track how often the dispensers were used even after their staff no longer wore RFID badges, thus enabling the researchers to determine de-activation compliance rates.

The main issue, Staats says, is more a question of how technology should be managed than whether technology works. "[People] may want a silver bullet, so they purchase something that they think will make their problems go away," he explains. "I think what we see [with the study] is the importance of committed leadership." If a hospital installs the RTLS solution and fails to oversee how it is being used—both initially and then years later—the technology may not be as effective as that hospital had hoped.

The study did not include research into the management policies that were in place in conjunction with each RTLS solution, nor how those policies might have impacted compliance rates. Nonetheless, Staats says, "the data set we have lets us speculate." The most interesting area of potential further research, he notes, is "what are the complementary practices" undertaken by hospital management that yield a boosted compliance rate that doesn't drop over time.

According to Staats, the researchers have no plans to carry out additional testing of RFID systems at this time. However, he adds, RFID and compliance is still area of interest, so if the opportunity arose, he and his colleagues might opt to undertake further studies.

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