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The relationship between Doctors' hand-washing committees and alternative fees

By Patrick J. Lamb

I just returned from a breakfast at which Stephen Dubner, one of the authors of Freakonomics and the sequel, Superfreakonomics, made some remarks.  He told the story about the work he and his co-author did studying the hand hygiene habits of doctors at a hospital.  Doctors self-reported washing their hands 71% of the time.  By studied observation, the true frequency was 9%.  Committees were formed, edicts were issue, all to no avail.  Keep in mind, this was an effort to convince the highest educated cohort in a hospital to do that which all of them acknowledged they needed to do.  The a carrot was used.  Doctors would be observed and each time they washed their hands, this observation group would give them a Starbucks gift card.  Still no real improvement.  Anyway, Dubner went on at length about the various steps the hospital took to try to get the doctors to do that which they know they should do.

I won't reveal what ultimately caused the doctors to change their behavior, but Dubner's conclusion is that changing human behavior is incredibly difficult.

What does this have to do with alternative fees?  Everything.

I have written numerous times that the behaviors required of a successful alternative fee lawyer are significantly different than those required to be successful under the hourly rate model, and that a firm cannot simply flip a switch and provide its clients with the value associated with effective alternative fee models.  If it took as much effort as it did to cause doctors to start doing something they acknowledged was important, what lengths will it take to cause lawyers to change behavior that has been ingrained into their psyche for decades? 

My colleagues and I exist in the petri dish of change from one model to another, and we are "true-believers."  We have experienced how hard the change is in an environment where there is no cultural ambiguity or mixed signals.  It is certain that the change will be exponentially higher in larger environments where the commitment to change is not as universal, or where the opposition occurs sub rosa? 

This discussion is not meant to discourage those who are seeing the need to change from taking steps to achieve it.  To the contrary, the more aware of the likely difficult, the more effort can go into "getting the doctors to wash their hands," or achieving the small behavioral changes that can be the building blocks of larger changes.  But this cautionary tale also should serve as a reminder to clients that merely being quoted an alternative fee is not evidence that behaviors have changed, and the need to look further is as acute as ever.

 

 

Full post as published by In Search of Perfect Client Service on December 06, 2009 (boomark / email).