The Hawthorne effect refers to the reality that people behave differently when they’re aware that they’re being observed. This interesting study demonstrated how the Hawthorne effect hinders the accuracy of direct observation (DO) as a means to measure HH compliance.
A real-time tracking system was used to determine if a healthcare worker was in the line of sight of an observer conducting HH audits. When the healthcare workers could see the observer, they were about three times more likely (90% compliant) to perform HH compared with when they could not see the observers (30% compliant)—a Hawthorne effect of 300%. The study was conducted in Toronto where HH rates are reported publicly; this overstatement of HH compliance was reported by the Toronto Star with the headline, “Ontario hospital staff not washing hands as often as reported.”4
One of the investigators, Dr. Michael Gardam, then the Toronto University Health Network’s director of infection prevention and control, is quoted in the Toronto Star as saying, “We’re fooling ourselves. The numbers that we are getting and we are posting publicly are not real, they’re artificial.”