Handwashing and psychology

The acronym KISS (Keep It Simple, Stupid) is attributed to the American aeronautical engineer Kelly Johnson.

On the face of it, simplicity makes sense, but it can be complicated. As Appleyard (2011) argues, ‘simple solutions don't work in a complex world’.

Few things are more complex (or should that be ‘complicated’?) than the way we think. We are prone to deviating from logical, reasonable thought and behaviour: we overestimate our knowledge, worrying more about the prospect of losing something than making a similar gain, and ‘[i]n the presence of other people we tend to adjust our behaviour to theirs, not the opposite’ (Dobelli, 2013:2).

Let us consider handwashing. It is clear that handwashing can prevent infections, yet the median compliance rate among health professionals is around 40% (Ibrahim et al, 2018). Even placing cameras to monitor handwashing protocols does not boost compliance rates to anywhere near 100%, as demonstrated by Ooi and Griffiths (2018). Before camera installation, the handwashing technique of obstetric surgeons conducting elective and emergency operations was recorded as 50% unsatisfactory, 20% satisfactory and 30% excellent. Post-intervention rates were 27.5% unsatisfactory, 30% satisfactory and 42.5% excellent (Ooi and Griffiths, 2018). Although the authors tried to mitigate the Hawthorne effect—when behaviour changes in response to observation and assessment (Sedgwick, 2015)—the participants still knew they were being monitored, yet 27.5% recorded unsatisfactory scores.