Utilizing Group-Based Contingencies to Increase Hand Washing in a Large Human Service Setting
A weekly staff lottery keeps hand-washing high for years without extra management work.
01Research in Context
What this study did
Bowman et al. (2019) ran a weekly lottery for 170 direct-care staff in a large residential facility. Staff who met the hand-washing goal went into a drawing for small prizes like gift cards.
The team used an ABAB reversal design. They turned the lottery on and off twice across two years to be sure the gains were real.
What they found
Hand-washing shot up when the lottery was on and dropped when it stopped. The change was large and lasted the full two years.
Managers spent almost no extra time once the system was set up.
How this fits with other research
Walmsley et al. (2013) got the same lift with a daily lottery for five students in a special-needs classroom. The core idea—tie hygiene to a fun group game—works for both kids and adults.
Choi et al. (2018) showed that feedback signs beat prompt signs in campus restrooms. Bowman skipped signs and went straight to a lottery, proving you can jump to consequences and still win.
Gravina et al. (2020) list training, prompts, and feedback as key pieces. Bowman kept it simpler: one lottery, no extra classes or posters, and still hit big numbers.
Why it matters
You can run this system in any large facility with almost zero daily effort. Pick a clear hygiene rule, set one weekly prize drawing, and watch the data climb. If you need to prove impact, turn the lottery off for a week and let the numbers speak.
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02At a glance
03Original abstract
Hand washing is the most important preventative measure for the reduction of contagious disease. Although hand washing is easy to perform, non-adherence is a ubiquitous problem. Several studies have demonstrated the effectiveness of multi-component intervention packages to improve hand washing among employees; however, interventions are limited to acute settings, are often implemented for a short period of time, and rarely, if ever, include information on long-term effectiveness. The purpose of the current study was to utilize a behavior analytic approach to determine the stimulus conditions under which hand washing should occur, and to assess and then implement a long-term monitoring system among direct care workers in a large, non-acute inpatient unit. A single-case repeated measures reversal design was used to evaluate the effectiveness of two interventions aimed at improving hand washing adherence. A lottery was found to be effective in increasing hand hygiene for 2-years with 170 staff.
Behavior Analysis in Practice, 2019 · doi:10.1007/s40617-018-00328-z