title: Social cohesion: The missing factor required for a successful hand hygiene program.
abstract: BACKGROUND
  There are limited explorations into hospital staff reactions to automated hand hygiene surveillance or hand hygiene interventions.
  
  
  METHODS
  An automated surveillance system with daily feedback and a behavioral intervention component was trialed in 2 wards in an Australian tertiary teaching hospital. After 9 months, 12 clinicians from each ward were interviewed prior to the completion of the trial to explore satisfaction with the system and behavioral component of nudging each other with a reminder to comply. Only on completion of the trial were transcripts analyzed for themes.
  
  
  RESULTS
  Staff from the ward with improved compliance described a socially cohesive team with a well-liked nurse unit manager who accessed daily compliance rates and worked with staff to set goals. This contrasted with the ward without improvement in compliance, whose staff described their great reluctance and discomfort to nudge each other to comply and distrust of the authenticity of the rates established from the automated system.
  
  
  CONCLUSIONS
  Interventions for improving compliance are more likely to be successful in a ward with a social cohesive team. Patient safety interventions, in the first instance, may benefit from purposeful selection of wards with cohesive teams and skilled leaders who can transform clinicians into early adopters of the program.
authors.affiliation: School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Yen Lee Angela
authors.initials: YL
authors.lastname: Kwok
authors.affiliation: School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Harris
authors.affiliation: Hospital Infection and Infectious Diseases Control, School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia. Electronic address: m.mclaws@unsw.edu.au.
authors.forename: Mary-Louise
authors.initials: ML
authors.lastname: McLaws
mesh_terms: D001315:Australia; D001331:Automation / Q000379:methods*; D000067289:Behavior Observation Techniques / Q000379:methods*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000379:methods*; D006784:Hospitals, Teaching; D006801:Humans; D007398:Interpersonal Relations; D062606:Tertiary Care Centers
keywords: Culture; Intervention; Interviews; Nudging; Qualitative; Trial