The Hawthorne Effect: What happens when no one's

watching?
by Erica Mitchell | August 3 2016

In
the 1920’s and 30’s, the nation was swept up in the Efficiency Movement, an effort to rid every aspect of
human life of waste and unproductive activity. Researchers were dispatched to factory floors, classrooms,
and even family living rooms with the mission of finding the optimal formula for efficient and productive
work, a formula supported by the new excitement over science and experimentation. Within this context, a
study was conducted at the Hawthorne Works, a factory making telephone equipment for Western
Electric, to determine the optimal illumination level for worker productivity. These experiments went on for
eight years, and ended with little fanfare. Decades later, however, Henry A. Landsberger revisited these
studies, discovering a pattern that revealed more about human nature than about workplace illumination.
This pattern still impacts research today, where it is known as the Hawthone effect.

What Landsberger discovered was that productivity increased for a short time any time the lighting was
changed. And any time a new cleaning regimen was introduced. And any time workstations were
relocated. In fact, productivity improved any time researchers were present, measuring
productivity. And thus was born the Hawthorne Effect, the tendency for experiment participants to
change their behavior when they realize they are being observed. Also called the observer effect, this
response is similar to the demand effect, when experiment participants adjust behavior in a way they
believe will please the researcher. But what does this say about human nature, and how does this impact
research in infection control?

Very simply, the Hawthorn effect means that people – doctors, nurses, patients, visitors – tend to
behave differently when they believe they are being observed. Researchers must take this into
consideration as they design their studies, building in elements to try to avoid this type of bias. But
healthcare workers in the field must also take this into consideration when adopting new interventions,
from new handwashing protocols, to daily chlorhexidine baths, to safer injection practices. We need to
remember that we, as human beings, tend to behave as required when under observation, but return to
old behavior when that observation is not present.

A recent study demonstrated the Hawthorne Effect clearly in the case of handwashing, where researchers
saw a 30% increase in compliance when healthcare workers were aware of being observed. Other
studies have shown the same result with hand sanitizer dispensers located within eyeshot of an auditor
vs. those that were not. Additionally the gradual “decay” or decline in the desired behavior has
been demonstrated in other areas of health care, including injection safety, environmental cleaning,
patient care, and on and on.

There are some interventions that can prevent this decay in desired behavior. One researcher, Dr. Peter
Pronovost of Johns Hopkins Hospital, has demonstrated that the use of checklists help healthcare
workers remember and complete correct protocols from handwashing to surgical procedures, prompting
him to create a mobile app to help patients and doctors prevent errors. Dr. Sanjay Saint of the University
of Michigan speaks to how group pressures of observation could be the way to changing behaviors in
healthcare settings. Other technologies work to provide backup to lapses in human processes such
as biocidal materials and electronic handwashing trackers.

We have all experienced the Hawthorne effect in our daily lives. We sit a little straighter at our desks as
the boss walks by, or use a reusable shopping bag at the organic grocery store. The idea has even
entered our aphorisms, with many phrases capturing the idea of being good whether or not someone is
watching. There is progress being made in ensuring that we are doing the right thing in healthcare, but
there is always room for improvement. The first step is acknowledging that this is a well-documented
aspect of human behavior, and then finding innovative ways to get us to all do the right thing, even when
no one is watching.

Source: http://blog.eoscu.com/blog/the-hawthorne-effect-what-happens-when-no-ones-watching