Nosocomial Infection and Choice Architecture

Hospital-borne illness is troubling, and in more than one regard. On the one hand, hospitals are where sick people go, so they are magnets for disease vectors. On the other hand, antibiotics suffer from a particularly tragic tragedy of the commons, leading to drug-resistant strains of bacteria. On yet another hand, even low-cost preventive measures like scrupulously hand washing by health care professionals or annual flu vaccines run the risk of being overlooked by harried, hurried personnel who spend their 12-hour or more shifts running from crisis to crisis. If you've got to deal with four codes in one night, you might well forget to scrub under your fingernails each time. On the (what are we up to here, fourth?) hand, hospitals have no requirement, and no organizational incentive to track nosocomial (hospital-borne) infection statistics. This means that even well-meaning researchers who would be interested in investigating the impact of interventions lack even the basic data to accomplish what should be rather easy analysis.

This is, as I see it, troubling. Troubling indeed.

Ideally, it'd be great if hospitals would compete on this margin. Imagine if your HCP would claim: "you've only got a 1 in 50 chance of getting sicker after visiting us! Compare that to the 1 in 25 rate you can expect from our leading competitor!" Well yes. Do imagine that for a moment. Savor it.

This is a situation perfectly tailored for behavioral economics. Medical delivery is loaded to overflowing with cognitive bias and heuristic thinking. Evidence-based practice is standard in modern medicine, but patients are not practitioners and bring occult prejudices to the examination room. Experimenting with what might make both patients and HCPs more compliant with basic best practices might be a very good idea, indeed.

But to do that properly, analysts need good data. Medicine will be all the more euvoluntary for it.

The curious thing for me is that I'm not sure how this cuts for my libertarian-ish priors. The world as she is sees a lot of coercion in medical delivery already. Could this be an instance where a little more might actually help increase overall patient liberty?