Impact of Hawthorne effect on healthcare professionals: a systematic review

Main Article Content

Woo Jin Choi
James J Jung
Teodor P Grantcharov



Background and Aims: The Hawthorne effect – the alteration of behavior by subjects due to their awareness of being observed – is evident in both research and clinical settings involving different forms of observation. However, the role of the Hawthorne effect on healthcare professionals and their practice are poorly understood. A systematic review of primary studies that examined the role of the Hawthorne effect on healthcare professionals was performed.

Materials and Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL were searched. Studies that discussed any changes in healthcare professionals’ performance or behavior due to observation or awareness of being studied were included. A quality assessment tool for observational cohort and cross-sectional studies was used to assess risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to report this review.

Results and Conclusions: In total, 23 studies were analyzed. 18 out of 23 (78%) studies showed behavioral change among observed healthcare professionals, and all behavioral changes led to increased productivity, compliance, or adherence to best practice guidelines or protocols. From 13 studies that observed only physicians as subjects, 8 (62%) studies reported a positive Hawthorne effect. 86% of studies using “direct” observation methods demonstrated positive Hawthorne effect in comparison to 67% using “indirect” observation. Of the five studies with post-intervention follow-up, four studies (80%) reported either diminished or decreasing Hawthorne effect within three months once observation ceased. Of the three studies with continued observation, two studies reported diminished Hawthorne effect. This systematic review demonstrated that healthcare professionals were affected by the Hawthorne effect. They tended to exhibit short- lived positive behavior change when observed.