At the International Association for Food Protection meeting last year, I called out to Chapman and said, what is the best part of my day?

Walking with Sorenne, to and from school, and elsewhere.

Later I asked Chapman, in front of all those people, what’s the most important thing we do?

He muttered and stumbled something.

The answer, that I repeat to all my kids, and all the kids I coach, is pay attention.

The hockey numbers are so low in Brisbane that I’ve got 11-year-olds on the ice with 5-year-olds. First lesson: pay attention, don’t kill the little kids (the older kids are actually quite protective of the younger kids and it is gratifying to watch).

So it’s not surprising that at the end of a long hospital shift, hospital workers wash their hands less frequently.

I see the same thing in hockey practice, where the kids are drifting off towards the end of 90 minutes on the ice, and that’s when problems happen.

The impact of time at work and time off from work on rule compliance: The case of hand hygiene in health care

03.nov.14

Journal of Applied Psychology [advance online publication]

Dai, H., Milkman, K. L., Hofmann, D. A., & Staats, B. R

Abstract

To deliver high-quality, reliable, and consistent services safely, organizations develop professional standards. Despite the communication and reinforcement of these standards, they are often not followed consistently. Although previous research suggests that high job demands are associated with declines in compliance over lengthy intervals, we hypothesized—drawing on theoretical arguments focused on fatigue and depletion—that the impact of job demands on routine compliance with professional standards might accumulate much more quickly. To test this hypothesis, we studied a problem that represents one of the most significant compliance challenges in health care today: hand hygiene. Using longitudinal field observations of over 4,157 caregivers working in 35 different hospitals and experiencing more than 13.7 million hand hygiene opportunities, we found that hand hygiene compliance rates dropped by a regression-estimated 8.7 percentage points on average from the beginning to the end of a typical 12-hr work shift. This decline in compliance was magnified by increased work intensity. Further, longer breaks between work shifts increased subsequent compliance rates, and such benefits were greater for individuals when they had ended their preceding shift with a lower compliance rate. In addition, (a) the decline in compliance over the course of a work shift and (b) the improvement in compliance following a longer break increased as individuals accumulated more total work hours the preceding week. The implications of these findings for patient safety and job design are discussed.