The actual cost of direct observation – why your organization should get on the digitalization journey

Direct observations using an old-fashioned pen and paper or wifi-connected tablets may seem as the most simple and cost-effective strategy to monitor hand hygiene. However, if we dig deeper, the actual expenses of direct observation will surprise you. 

How many direct observations are enough?

The Leapfrog Group, which provides the only hospital rating focusing exclusively on safety, has been advocating for 200 observations per unit each month. This number is based on the study by Yin et al., which showed that 180-195 opportunities would need to be monitored to accurately observe a 10% change in hand hygiene compliance. Moreover, the observations should take place on all days of the week and throughout all shifts.

To illustrate an example, a medium-sized hospital with 200 beds across 6 units would need to monitor and report 1200 hand hygiene observations per month to score high on safety measures. 

The actual costs

According to Hand Hygiene: A Handbook for Medical Professionals, the hand hygiene procedure takes an average of 10 minutes to document in a common setting. Therefore, gathering required hand hygiene data for a 200-bed hospital would take approximately 12,000 minutes, or 200 hours, every month. This would require more than one full-time employee to do nothing other than hand hygiene observation. 

Realistically, most hospitals won’t be able to satisfy the criteria with their present employees successfully and will instead need to hire more personnel to carry out the direct observations.

If we do the math, 200 hours X 22 € /hour (based on an hourly wage for RN in the UK) = €4,400 per month or €52,800 per year for direct observation only. 

Moreover, extra time is required for tasks such as training and validating the observers, reporting and disseminating the data, and intervening when hand hygiene practice falls short of expectations. 

Due to large hospital variability, there is no data on how much time this takes. However, it is well-known that analyzing the data from direct observations can be time-consuming, challenging for personnel in many hospitals, and can take several weeks to complete. Similarly, finding and training new personnel can be problematic due to the nature of the profession. 

Therefore, if we make a realistic estimate considering all the things, the total cost for direct observation in a standard 200-bed hospital could rise to more than €70,000 per year


Electronic hand hygiene monitoring: a cheaper alternative to direct observation

Hospitals using electronic hand hygiene compliance monitoring systems (EHHMS) such as the solution by Sani Nudge can reduce internal direct observation efforts, saving time and costs for the hospital while significantly improving the quality of data. The hospital doesn’t have to pay for an additional headcount to perform observations because EHHMS automate the collection of hand hygiene data. As a result, the staff members who had to take time away from their regular tasks to act as “secret shoppers” (a job that no one enjoys) can now concentrate on meaningful tasks that directly impact the staff and patient safety. 

How much can you save?

While adding all the expenses for direct observation, it is apparent that cost becomes unsustainable. Hospitals using the EHHMS can save many financial resources but also harvest other benefits _when shifting from using direct observation as the only method for hand hygiene monitoring.

Indirect savings and value drivers 

Most importantly, Sani Nudge and other leading EHHMS go far beyond simple hand hygiene monitoring. 

  • Reduction in HAIs 

If a system improves hand hygiene compliance, a decline in both the frequency and expenses associated with HAIs naturally follows. 

Sani Nudge enables hospitals to significantly improve compliance through actionable insights and improvement tools, leading to a radically decreased rate of HAIs. For example, using the Sani Nudge solution for one year, a university hospital achieved a 67% reduction in HAIs.

  • Reduction in Staff Absenteeism 

The relationship between staff hand hygiene levels and absenteeism shows a return of investment opportunity for hospital management while increasing patient safety. High absenteeism rates can exacerbate staff shortages, and attracting new staff can become challenging. This can, in turn, negatively impact a hospital’s ability to treat new patients. 

Healthcare organizations that introduce data-driven group feedback interventions using the Sani Nudge system increase their hand hygiene levels and decrease staff absenteeism significantly. Improved hand hygiene results in a healthier workforce.

  • Sustainable Improvement Through Positive Reinforcement 

For the benefit of the patients being treated and the satisfaction of the staff utilizing the system, the ideal system should use positive reinforcement to guarantee sustainable long-term behavior change.

Sani Nudge offers improvement tools, data, and frameworks that make healthcare workers champions of hand hygiene. Anonymous and measurable analytics make it easy for hygiene mentors to plan and execute improvements while utilizing the nudging feature as positive reinforcement. 

  • Staff Satisfaction Due to Ease of Use and Safety Environment

The right system should be easy to use so that healthcare workers can integrate it into their daily routines without impacting their workflow. 

Sani Nudge has been designed with this principle in mind. The technology is non-intrusive, and the badge doesn’t disturb healthcare workers with sounds or vibrations, which leads to high staff acceptance rates. Moreover, it enables healthcare professionals to carry out their work without worrying about infecting themselves, their patients, or their loved ones back at home.

The Bottom Line

Aside from the cost and limited sample size, direct observation has another inherent issue that directly affects the quality of data collected – the Hawthorne effect. Because HCWs know they are being watched, the compliance rates artificially increase (sometimes by as much as 300%) (1). This makes it nearly impossible to estimate hand hygiene levels in a facility accurately. 

Investing in an electronic hand hygiene monitoring system is more cost-effective than direct observation and, importantly, much more accurate – saving patients’ lives.

Book a live demo with Sani Nudge today and improve hand hygiene at your facility. 

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