New Website:, Buttons That Put the Quality Burden on Customers


ask me if buttons

I've been writing for a long time  that I think it's inappropriate and ineffective to ask patients and families to inspect or police hand hygiene in hospital settings. It's the job of healthcare leaders to create systems that include enough time for nurses, doctors, and others to properly practice hand hygiene in the name of protecting patients.

Hanging more posters and cuter signs doesn't work… lack of hygiene is not an education or awareness issue – it's a systems, processes, and leadership issue.

For years, I've gently mocked the “ask me if I've washed my hands” buttons that some staff are asked (or forced) to wear.   I've pointed out that no other industry puts this quality inspection burden on their customers.

So, I've created a website, with parody buttons that seem silly in other situations… so hopefully the “ask me if I've washed my hands” buttons will seem silly, as well – and we can try things that might work. Read more about the new site here. And see the other buttons, including “Ask Me If I Will Not Operate on the Wrong Side.”  See the other buttons here.

Proceeds from the sales of any buttons will be donated to the Louise Batz Patient Safety Foundation, where I am a board member.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. I’m not sure I necessarily agree that those buttons in particular are such a bad idea. If you consider for a moment that they are perhaps not intended for the customer at all, rather that they are to make the wearer feel more aware that the customer is always watching, then that can only help encourage the culture you want.

    • These buttons have been in use (and sold by The Joint Commission) for many years. If anybody can produce evidence that wearing these buttons:

      1) increases hand hygiene compliance rates
      2) reduces infections or improves patient outcomes

  2. I love this (5 minute) video showing the effectiveness of relying on the usual suspect countermeasures to the hand hygiene problem:

    A good demonstration of the need for multi-pronged approaches. Signs, education, and risk awareness are not sufficient.

  3. After writing work instructions for years I probably scrutinize verbiage and signage more than necessary. When I see 1% milk on the shelf my thought is always “does anyone ask what the other 99 percent is?” In public restrooms “Employees required to wash their hands” I wish it would read “Everyone required to wash hands”. I also noticed more high schools designed with sinks in full view of hallway. Is this so students are shamed into washing hands? Makes you go hmmmm….

  4. From a discussion on linkedin:

    Seems one sided to say this puts the “burden” on patients? Does it not also prompt patients to ask questions? I do a lot of work in Healthcare and a number one complaint of patients / residents / clients is they do not understand their care. (The first principle of Lean is understanding the voice of the customer) When patients are additionally asked if they feel comfortable asking a care giver about their care the answer is quite commonly “no”. We just finished a survey at a major Canadian hospital and 87% of people did not understand their care and 84% did not want to ask questions. This button to me represents an open door to “talk to me about your care.”

    My response:

    You’re right that patients are often afraid to speak up. I’d like I see data that shows the buttons help facilitate this discussion. Scared patients + buttons could still equal silence and people not speaking up. But, still, my point is that hospitals need to take responsibility for quality and not make patients speak up. Airlines don’t put a burden on passengers to speak up about safety…

    His reply:
    I still believe you are over simplifying the situation. The problem with a lot of healthcare measurement is we tend to measure the wrong thing. The “speaking up” is not what the buttons are measuring. If you want to know if the buttons are working then measure hospital acquired infections after implementation of the buttons, did it change staffs behaviour? Its like measuring compliance to surgical check list completion as a measure of patient safety? There may be a relationship but the true measure is reduction of surgical site infections, incorrect surgeries etc. not compliance to complete a check list. And I have a lot of data to support this.

    My response:

    If you have data that shows at least a correlation between wearing the buttons and lower infection rates, please point me to that. I stand by my point that no other industry expects their customers to perform quality control inspections – it is the responsibility of the people providing a service, especially an important service like healthcare.


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