Understanding Variation in Hand Hygiene Practices of Healthcare Workers Through Routines Theory

Abstract

The following study represents the Master Thesis for acquiring the MA in International Business Communication – Multicultural Communication in Organizations at Copenhagen Business School. Healthcare-acquired infections are a huge burden for patients as well as healthcare systems. Many of them can be prevented through hand hygiene carried out by healthcare workers. However, compliance rates are low. The goal of this thesis is to explain variance in the hand hygiene practice of healthcare workers by investigating it through the lens of routines theory. This study builds on routines as conceptualized by Feldman and Pentland (2003), who see them as dualisms of understandings and performances that constrain and enable each other. This way, I expected to get insights on how healthcare workers conceive of the hand hygiene routine and how this consequentially influences their hand hygiene performances. To better understand the hand hygiene routine, I analyzed various material representations of the routine, such as guidelines, E-learning, posters, and others. I moreover conducted observations at two hospitals in the Danish capital’s region to detect differences in hand hygiene performances as well as gain further knowledge on the subject. I find that health care workers have a strong overall understanding of hand hygiene on the one hand, but a weak and diverging understanding of many of its details, such as correct duration and steps of HH, on the other. A flawed understanding of these aspects results not only in missed hand hygiene actions but also flawed performances. Furthermore, I find that hand hygiene misses and flawed performance occur for different reasons and should thus be tackled as separate challenges.