Why don't doctors wash their hands? A correlational study of thinking styles and hand hygiene

Background: The World Health Organization has identified cognitive determinants of hand hygiene as an outstanding research question. This study investigated whether doctors' preferences for a rational thinking style or an experiential thinking style are associated with hand hygiene compliance. Methods: This was an observational study of hand hygiene practices of 32 doctors in 2 teaching hospitals in South Australia. Compliance rates were correlated with self-reported thinking styles. The doctors were observed by a trained observer during a ward round or outpatient clinic and were unaware that hand hygiene was under observation. The main outcome measures were hand hygiene compliance (hand hygiene compliance tool) and thinking style (Rational-Experiential Inventory). Results: An overall mean compliance rate of 7.6% (standard deviation +/- 7.2 %) was found. Compliance was significantly positively correlated with experiential/automatic thinking (r = .46; P = .004) and the observational setting of ward rounds (vs clinics) (r = .47; P = .003). No significant relationship was found between compliance and a rational/deliberate thinking style (r = -.01; P = .472). Conclusions: Hand hygiene is more experiential than rational. Findings suggest that certain promotional strategies appealing to the experiential thinking mode may improve compliance, and that traditional approaches based on logic and reasoning alone probably will not work.