How visual reminders improved hospital handwashing by 43%

Nudges: Nudges are gentle suggestions towards the desired outcome which are created by subtly altering the context in which we make our decisions. They often occur below the level of our conscious awareness.

EAST Framework: The EAST Framework is a set of guidelines designed to make behavioral science interventions more effective. The four quadrants of the framework state that an effective intervention must be Easy, Attractive, Social, and Timely. Even if an intervention doesn’t include all four, its effectiveness drastically increases when any facet of the EAST Framework is used.

Handwashing as a barrier to hospital infections

If the COVID-19 pandemic has taught us anything, it is the importance of washing our hands. Washing our hands helps us protect ourselves and others from dangerous pathogens. This is especially important for healthcare professionals who are in near-constant contact with various diseases. Unfortunately, healthcare professionals are often highly stressed or short on time, which can result in a lack of adherence to common hygiene practices. This lack of basic hygiene can result in dangerous side effects, such as hospital acquired infections which can result in increased mortality, morbidity, absenteeism, and treatment costs. 

Nyt Hospital Nordsjælland x Krukow

In 2016, Nyt Hospital Nordsjælland in Denmark was struggling with staff hygiene compliance. While they had not experienced an outbreak of hospital acquired infections, they were concerned that the lackluster hand-washing practices of their workers could likely lead to one in the future. Enlisting the help of Kurkow, a Danish behavioral design firm, the hospital got to work nudging their staff towards better hygiene practices. 

Text to visual reminders

Kurkow observed that Nyt Hospital Nordsjælland’s hygiene reminders were largely in text format. While we can presumably read well, our brain has largely evolved to better understand visual cues. This is why we typically find it more cognitively difficult to understand a paragraph of instructions than to get the gist of an image that represents the same step-by-step process. Acknowledging this insight, Kurkow set out to transform all of the hospital's text-based information into useful visual guidelines. 

Some methods used in making these visual cues effective included creating visual guidelines to show the physical position of the sanitation station in the room and breaking down the sanitation procedure into a tangible, step-by-step formula. 

The EAST Framework

When we examine frameworks that are used for applying behavioral science, it is clear why this nudge was so effective. In the Behavioural Insight Team’s EAST Framework, the first pillar for crafting an effective behavioral intervention is making your message cognitively easy, as simplifying is perhaps the most effective way to make your goal understood. In this example, this simplicity is represented in the replacement of thick blocks of written cues with simple images, which are far more likely to be observed and understood by busy healthcare workers.

This intervention also takes advantage of the second pillar of the EAST Framework, which involves making the message more attractive to the group you are targeting. Kurkow did this through the use of colorful, attention-grabbing images that would be highly attractive to our visual-oriented minds. 

43% increase in correct hand-washing procedures

Overall, the project has an array of positive effects, despite its simplicity. Measuring the amount of correctly performed hygiene procedures, Kurkow saw a 43% increase after implementing the visual design strategy. Before the experiment was set in place, the hospital’s healthcare workers only performed proper procedures 16% of the time, whereas after the procedure compliance to hygiene standards reached rates of nearly 60%. 

Less risk of infections

In addition to these short-term hygiene benefits, the resulting behavior change should lead to fewer hospital-acquired infections and hospitalization in general. Gentle nudges like this, despite their perceived simplicity and low costs, can surely minimize human pain and suffering in the long haul over a spectrum of applications. 

• The intervention improved outcomes for participants
• More information on privacy and consent is needed, as well as knowledge on the effects across demographics

Evidence-Based Strategies for Washing Your Hands: If you are further interested in evidence-based ways to improve handwashing, look no further than Karine Lacroix’s article on the subject. Similar to this intervention, this article applies the EAST Framework to the issue of handwashing and gives many alternative strategies of how to apply these techniques to ensure ourselves a cleaner, safer future. 

Encouraging Social Compliance During COVID-19: During a global health crisis, compliance to things like handwashing and mask-wearing are essential for protecting ourselves and others. In this piece, TDL’s Siddharth Ramalingam examines how we can use similar techniques to the ones used in this intervention to help maintain public health safety standards during COVID-19.