Orland Evangelical Free Church | New York Times Readers and Compliance

Times readers are in management. They may be administrators at universities or high schools, corporate department heads, or case workers in county social services. They may also be hospital administrators, whose point of view is dramatized in a column by Stephen J. Dubner and Steven D. Levitt called, “Freakonomics: Selling Soap.” The article was published Sunday and remained #3 on the most e-mailed list Wednesday.

Managers live at the intersection between one person’s behavior and another’s. If Mabel the assistant supervisor goes outside to smoke on her break, the breeze will carry her toxicity to case worker Gertrude’s window, which is always open for the fresh air. How does one persuade/manipulate/compel Mabel to smoke somewhere else?

Experimentation ensues. One announces a healthful living program, in which employees who lose weight or quit smoking are rewarded with free lattes. A dozen people sign up, but not Mabel. One then installs a park bench in the shade of a fruitless pear on the far side of the parking lot. One adds an ash tray but Mabel persists in her usual spot.

One finally suggests to Mabel that she travel to the bench for her breaks, rather than stand in the blazing sun. But she wants a tan.

Ultimately, a new rule: For the sake of energy efficiency, all windows must remain shut.

At Cedars-Sinai Medical Center, management decided to address a problem of greater magnitude. The Institute of Medicine estimates “that anywhere from 44,000 to 98,000 Americans die each year because of hospital errors – more deaths than from either motor-vehicle crashes or breast cancer – and that one of the leading errors was the spread of bacterial infections.”

In persuading staff to wash up, Cedars-Sinai had a compelling motivation: an upcoming inspection by an accrediting organization. “[I]t simply wouldn’t do for a world-class hospital to get failing marks because its doctors didn’t always wash their hands.”

Doctors became management’s focus, since they notoriously ignore the Purell dispensers most. To get information about doctor compliance with hand-washing regs, administrators recruited the nurses as informers, exploiting a deep fault-line in hospital culture.

Management then used two tools to change doctors’ behavior: incentives and marketing.

The Hand Hygiene Safety Posse tracked down not violators but the compliant in the wards. If they caught a doctor washing his hands, they gave him a $10 Starbucks card. Compliance rose from 65 to 80 percent. Good but insufficient.

Marketing made the breakthrough, though it took a while. After e-mails, faxes, and posters didn’t work, senior administrators handed out bottles of Purell at the physicians’ parking lot entrance. Inspiration hit when an epidemiologist took cultures of top doctors’ hands and had the results photographed. The photos “were disgusting and striking, with gobs of colonies of bacteria.”

One of the images “was made into a screen saver that haunted every computer in Cedars-Sinai.” Compliance hit nearly 100 percent.

The e-mailing of this story around the nation is easily explained: admiration for brilliant marketing.

But eventually the attitudes of American administrators toward the people they manage are disturbing. In a society with weak common ethics, the only criterion of goodness becomes compliance. Where compliance is the goal, leaders manipulate their people. Those who manipulate effectively are rewarded.

Yes, the successful incentives are shrewd. Yes, the compact messages of marketing are, in their way, elegant. But careers full of ploys are symptoms of decadence. Our cynical society is not one in which people want to live – not even managers.