Behavioral Science Strategies for Reducing the Spread of Illnesses in Organizations
By Jessica Nastasi, M.A., BCBA and Nicole Gravina, Ph.D.
On December 31st, 2019, the World Health Organization (WHO) was informed of an outbreak of pneumonia, now dubbed the coronavirus or COVID-19, in Wuhan, China. By January 20th, 2020, the first case of COVID-19 was reported in the US, and ten days later the WHO declared the coronavirus a public health emergency of international concern. On March 10th, the US surpassed 1,000 confirmed cases of COVID-19. On March 11th, the WHO declared the outbreak a pandemic. The rapid spread of COVID-19 indicates a person-to-person mode of transmission, and reports of community spread cases (i.e., infection without a clear mode of transmission) continue to increase exponentially.
The workplace can serve as a hub of disease transmission if proper precautions are not enacted. Many workplaces provide essential services to the community, and some employees cannot afford to miss work. When workplaces must stay open, and employees cannot work remotely, the Center for Disease Control and Prevention (CDC) recommends that all employers consider several preventative and reactive strategies for decreasing the spread of COVID-19 and other illnesses in the workplace. These recommendations include:
- Encouraging sick employees, clients and customers to stay home
- Performing routine environmental cleaning to disinfect areas subject to frequent human contact
- Handwashing or hand-sanitizing
- Avoiding touching the face
- Avoiding close contact with others
Behavioral science has studied strategies for increasing workplace behaviors that reduce the spread of illness. Below we outline recommendations for encouraging some of these workplace behaviors based on behavioral science research.
Teach proper hand hygiene. If you were to enter any given bathroom before this pandemic, you’d probably observe many people washing their hands … improperly. The CDC handwashing checklist recommends washing hands while rubbing all surfaces for at least 20 s; time roughly equivalent to singing the “happy birthday” song twice. When handwashing isn’t an option, hand sanitizers with at least 60% alcohol can be used, covering every surface of the hands. The CDC offers useful signs that can aid in training proper hand washing. While employees may need to learn the appropriate handwashing procedure, it is likely insufficient to create sustained behavior change without other intervention components.
Reduce response effort. Employers can reduce response effort by making hand sanitizer readily available in the workplace. For example, employers could place portable hand sanitizer in multiple locations in the workplace to reduce the effort required to clean hands (Gould et al., 2017). A study conducted by Fournier and Berry (2012) found that well-placed hand sanitizer increased hand hygiene compliance among university students from 0% to 60%, when combined with informational signs.
Add reminders. Employees may need reminders to wash or sanitize their hands regularly. Reminders can include signs, texts, emails, face-to-face communications, or schedule-based (e.g., start every meeting by passing around sanitizer). Cruz et al. (2019) increased staff handwashing by 2 out of 3 participants in a clinic that served children with autism by having supervisors remind them by email to wash their hands. The third participant required feedback to improve her performance.
Feedback. The most effective intervention for improving hand hygiene in the research literature is feedback , meaning, giving employees information about their performance. Researchers have improved hand sanitizing in a hospital by using package interventions that included feedback. A simple feedback intervention could involve inconspicuously observing employees when they should be washing hands (e.g., when returning from lunch) , and posting a feedback graph of the observations. After a training intervention failed, Geller and colleagues doubled handwashing in a university cafeteria by providing employees daily feedback on their performance.
Self-monitoring. Self-monitoring involves recording your own behavior, which can occur after each behavior or at the end of a time interval. In a series of studies conducted by Steve Hayes and Rosemary Nelson in the late 70’s and early 80’s, researchers found that self-monitoring was an effective intervention for reducing face touching by college students during class. The intervention reduced student face touching by 50% or more across studies (e.g., Hayes & Cavior, 1777; Hayes & Nelson, 1983; Nelson et al., 1982)
Make it salient. One challenge with reducing face touching is that we often engage in the behavior without noticing it. We can make our behavior more salient by sitting in front of a mirror, putting something on our finger (e.g., bandage), or by wearing a wristband with a bell attached. The added visual, tactile, or auditory stimulus could improve our ability to self-monitor, and in turn, reduce the behavior.
Recruit a friend. If we are having a difficult time noticing our own face touching, we may be able to recruit a friend or family member to offer feedback when we touch our face. Incentivize your friend for mentioning the face touches by offering them a quarter or another reward every time they catch you touching your face. Send the cash you owe them via Venmo, though – money is full of germs.
Create a checklist. Almost every cleaning study we could find in the behavior analysis literature included a checklist that clarified the cleaning tasks and expectations (e.g., Anderson et al, 1988; Doll et al., 2007; Pampino et al., 2004). Checklists should be simple and can include photos of the space when it is clean. Employees can use checklists as self-monitoring tool, checking off items as they complete them.
Feedback. Observations can be conducted throughout the day or at the end of the day to measure cleaning completion. Researchers have used public group feedback as well as individualized feedback to improve cleaning performance. In a study conducted at a university bar, Anderson and colleagues (1988) assigned each employee a code and posted individual cleaning performance publicly so that employees could see their performance with respect to other employees, without being able to identify them. While task clarification improved cleaning performance by 13%, the addition of graphic feedback improved performance by 37% more.
The CDC also recommends social distancing, which is a public health practice meant to prevent sick people from coming into contact with healthy people. Social distancing involves avoiding places where people congregate, and when in public, maintaining a distance of at least 6 ft. However, this is not feasible for all occupations.
If employees must be in the workplace, employers can still take steps to increase the distance between people and decrease the number of people they contact by examining the process. For example, librarians could select books for people who order them in advance and leave them at the front door. Employees who work in autism clinics could work with one child for the full day in an isolated room, and supervision could be conducted remotely. Grocery stores could encourage customers to use the automated checkout system and gas stations could request that people use credit cards at the pump. Employers can examine their work process to identify all points of person-to-person contact and determine if changes in the process can reduce the amount of contact. Although these process changes may not be ideal for the organization, they are temporary solutions to reduce the spread of illness.
The number of COVID-19 cases continues to increase exponentially in the US. Organizations can play a critical role in preventing disease transmission and protecting employees who are unable to avoid community exposure. Researchers have demonstrated that simple antecedent and consequence-based interventions can markedly improve behaviors that reduce the spread of illnesses at work. We suggest employers enact some of these strategies right away to help slow the spread of illness and protect the most vulnerable members of our communities.