Healthcare acquired infections represent a significant cost to patients and the hospitals who care for them. Simple hand hygiene (washing hands for 20 seconds or longer) offers one of the best ways to prevent the spread of infection. But hospitals routinely struggle to reach this target. The designers at Jefferson Innovation, a hub for developing digital healthcare products, set out to tackle this problem.  


First Prototype

Jefferson Innovation developed a system to anonymously record the length of time spent at a handwashing station, paired with a small series of 20 second videos designed to entertain users. After installation, compliance immediately rose, but after two weeks, gradually declined. The designers wanted to know, “what content should we provide?” and “how often do we need to change it?” in order to maintain user interest. Myself, along with with another graduate student, worked to answer their questions.


Design Considerations

Hospital rooms should be as quiet as possible to allow for rest and recovery, so we knew our videos would need to be silent. Additionally, the screen couldn’t be touched, as we needed to minimize the number of surfaces that could potentially spread infection. Therefore, we needed to design content which was silent and static, yet interactive and engaging.

Research Process

We interviewed dozens of clinicians: nurses, medical students, residents, and doctors, in order to better understand daily life in the hospital. In addition to asking about their experiences and struggles with handwashing, we also wanted to know what motivated them. We believed that if we could better understand their primary drives, we could create content which offered engaging rewards. We also interviewed behavioral analysts and researched methods in positive psychology to better understand how to motivate and encourage the behavior we wanted to see: washing hands for 20 seconds, every time.



We determined that our users were highly motivated by achievement. These clinicians wanted to do things correctly; they wanted positive outcomes for their patients and the hospital. So we needed to pair their desire for achievement with content which rewarded them for handwashing compliance. We offered rewards in the form of:

  • Timers: Rather than distracting users from the task at hand, we sought to immerse them in the experience of time. By offering varied and engaging animations which effectively functioned as stop watches, we wanted to reward users with a sense of accomplishment for reaching the goal. In the same way that people enjoy assembling puzzles for nothing more than the satisfaction of completion, we want to offer a reward for accomplishing the routine, but enormously significant  task of completing 20 seconds of handwashing.


  • Recognition: Publicly celebrating units which reach their compliance targets offers a powerful social reward. While we cannot offer an interactive social experience (no user generated content, commenting, or “like” button), we can strengthen social ties by highlighting units and individuals and their important efforts in keeping patients safe and healthy.


  • Meditation: Clinicians endure extremely stressful and busy conditions while at work. Many of our interview subjects reported difficulty finding time to eat food or even use the restroom during their shifts. We wanted to reward our users with a sense of calm and stillness in the midst of their chaotic days. By combining simple breathing exercises, coupled with outdoor scenes, users are rewarded with a small sense of rest and stillness.



After correctly pairing a reward to the motivation of our users, we needed to create a system of high variability.

Social networks, with evergreen user generated content, provide an experience of infinite variability. Each time a user engages with the product, it will be new and exciting. We struggled to create a closed content system which would continue to engage users. A simple solution would be to provide 20 second segments of a news feed or other outsourced commercial content. However, commercial news, while infinitely variable, doesn’t reward our users with a sense of achievement. So we studied how to create procedurally generated animations, designed to display visually unique content each session.

Borrowing concepts from the video game industry, such as the procedurally generated “No Man’s Sky”, we believe we can create a highly variable system of rewards to encourage handwashing compliance.