Alternatives to the medical checklist?

In Maryland, state leaders recently kicked off a program that will send 45 teams of observers to 47 hospitals to record the hand-washing habits of doctors and nurses. Governing Magazine calls the teams, spies. They have to be anonymous in order to alleviate the potential Hawthorne effect.

So far, the medical checklist is the most successful and best known nudge for improving hand-washing habits in hospitals, but the program’s FAQ makes clear it is open to other strategies that include “campaign branding, addition of new members to the multidisciplinary HH (hand hygiene) team, hand hygiene education, signage, environmental enhancements, improved reporting process, new tool development, enhanced communications concerning HH, and others.”