Quality goes up, mistakes go down when people know their work is being evaluated

Quantum mechanics, at first glance, seems like it has nothing in common with human behavior. But what if human behavior was actually influenced by quantum mechanics?

One of the most mind-blowing experiments I recall learning about in my advanced physics classes is the famous double-slit experiment. Without getting too deep in the weeds of quantum physics, the experiment basically demonstrates that a particle behaves one way when there is an observer, yet behaves completely differently when not actively observed. In other words, whether or not someone is observing the experiment directly impacts the outcome of the experiment.

If particles behave differently when being observed, what about living, breathing human beings? Does quality of human work product improve or decline when workers know they are being watched?

A recent peer-reviewed article in the highly respected medical publication, JAMA Internal Medicine, seems to indicate that humans are also influenced by whether or not an observer is present. The question that the researchers in the study asked was, “What is the effect of heightened vigilance during unannounced hospital accreditation surveys on the quality and safety of inpatient care?”

Ars Technica’s Beth Mole has more:

To catch the slack-off level in hospitals, the researchers looked at 30-day mortality outcomes of Medicare patients hospitalized before, during, or after the week when a hospital was getting a routine inspection by The Joint Commission. This is the nonprofit organization that accredits hospitals. The researchers sifted through records on 1,984 general hospitals between 2008 and 2012. They picked out data on 244,787 patient admissions during 3,417 week-long hospital surveys. They then compared that data with that from 1,462,339 admissions in the same hospitals during the three weeks before and after those survey weeks.

Overall, they found a 1.5 percent decrease in the mortality rate during inspection weeks compared with normal operating weeks. But the effect was greater in major teaching hospitals, which have their elite reputations on the line as they try to dazzle inspectors. In these hospitals, mortality rates decreased by 5.9 percent. If that decreased rate stretched over an entire year in those hospitals, it would mean around 3,600 fewer deaths, the researchers estimated.

The team wasn’t able to figure out precisely what hospitals do differently during inspection weeks that caused the death-rate dips. They didn’t see significant changes in the rates of death from certain infections, cardiac arrests, or post-surgery complications. Instead, the authors speculate that the improved mortality rates overall may be due to staff’s heightened vigilance and stricter adherence to protocols and procedures.

What’s the Point?

When it comes to human behavior in the design, construction and management of the built environment, failures and missteps — particularly the kinds that impact performance, occupant health, useful life, etc. — are almost always the result of inconsistency. In other words, the typical kinds of defects we see are rarely the result of overt acts or negligence, but are instead caused by momentarily lapses.

The challenge then for quality assurance, is that most practices involve spot-checking already completed work, ideally in the form of randomly selected representative sampling.  With the advent of the so-called Internet of Things (IoT), it is quite conceivable that within a few years it will be possible to collect qualitative data about all activities on a given project. Processing and making timely decisions based on that massive amount of data will be another challenge to overcome, but at least the capability for collecting the data exists.

So for example, if craftsman of a given trade knew that every single assembly they worked on was going to be inspected as part of a thorough QA process, would they behave differently than if they know that only certain assemblies or locations will be spot-checked?

According to the findings by the researchers in this JAMA article mentioned above, the results may yield a slight, yet still perceptible impact on the quality of human work product.


  1. JAMA Internal MedicinePatient Mortality During Unannounced Accreditation Surveys at US Hospitals
  2. Ars TechnicaWhen inspectors swoop in, hospital staff save more lives
  3. Wikipedia: Double-slit experiment
  4. Image of CERN Large Hadron Collider (the largest man-made machine ever, designed to expand our understanding of particle physics) courtesy Wallpapershome.com