Risk management is,
for better or worse, a constant business challenge. As examples, I’ve given recent
attention to the timing mis-alignment between senior-level compensation and
litigation exposure – here – and the perils of failing to assure a long-term
plan for business sustainability – here.
How about a major
unmanaged public health risk – the threat of wider-spreading swine flu – that
exists right now at the heart of the health system. A large regional hospital
is ignoring our mothers’ most basic admonition: “Hey, wash your hands!”
I spent last
weekend visiting a loved one, who is recovering remarkably from complex,
life-threatening and brilliantly executed surgery. That much, the hospital had
right.
Outside his room,
and all along the wards, there were dispensers of hand-sanitizing gel – which
the staff all used in diligent compliance with the posted signs.
Frequent use of
soap-and-water or alcohol-based sanitizers is a low-cost, front-line tool in
the fight against contagion (see here and here). So what was missing?
It was the complete
lack of attention to the hundreds of daily visitors – a steady stream of
arrivals from who knows what cesspits of contamination, spreading out through
the hospital to hug and pat the patients, fluff the pillows, handle all the
medical playthings, and shake hands with the doctors and nurses.
There was not one
word of direction or support to disinfect this parade of the unwashed, before
they acted as a delivery service for infectious pathogens from the ugly and
germ-ridden outside world.
In my business
school course on Risk Analysis and Management, we spend time on the problems of
incentives – how to recognize and adjust the influences that lead to good or
bad choices.
Personal issues
include the difficulty of balancing immediate consumer spending against saving
for future retirement, and succeeding with the well-intended plans for diet and
exercise that fall victim to daily distractions and temptations. On the
business side, as recent history has shown, mortgage brokers paid for volume
will push subprime loans on unqualified buyers, and banks that off-load dodgy
financial products pay out huge bonuses despite the inevitability of
catastrophic future reckonings.
My class looks at
the kind of cost-effective and minimally intrusive techniques laid out in the
book “Nudge,” by the University of Chicago’s Cass Sunstein and Richard Thaler –
here -- who explore situations ranging in complexity from the location of sweet
desserts in a cafeteria line to retirement plan investment options to carbon
mitigation techniques affecting climate change.
Which has what to
do with promoting germ-reduction in a hospital? My students would zero in on
the hospital’s unanswered question:
Why was there not a
hand sanitizer conspicuously located at the reception desk – a control point
where visitors must pass? What would it take?
There would be no
cost to the hospital, since the devices are already stocked for staff use. No
visitors would resist, since no fee or other imposition is involved, and in any
event their wish for admittance creates ample motivation to cooperate.
In terms of Thaler
and Sunstein’s search for the gentlest possible nudges toward hand-hygiene compliance,
a research opportunity could test and evaluate for the most effective among the
various levels of encouragement:
-
No sign
at all might be needed, besides the clear and present reminder of the dispenser
itself.
- There
could be a simple sign: “Please help prevent the spread of flu.”
- Or the more
aggressive: “It’s state law – visitors must use sanitizers.”
- Or the
truly coercive – ultimately effective if perhaps a bit harsh: “Failure to use
hand sanitizers is liable to punishment, including amputation.”
Broader lessons may
lurk in the “teaching moment” of this hospital’s readily achievable illness-reduction
opportunity, for the identification of “clean hands” incentives to promote
fiscal or economic or corporate health and safety.
For now, I concede
my ambiguous emotions about going into hospitals -- because they’re always full
of sick people. I would feel better, though, only knowing at least that by
nudging everyone on their premises to use proper hand-cleaning techniques, they would be lowering my risk of
leaving with my own case of swine flu.
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