A large literature and repeated controversies have evolved over many decades as to the nature of the Hawthorne effect [5,10]. If there is a Hawthorne effect, studies could be biased in ways that we do not understand well, with profound implications for research [11]. However, if employees perceive ulterior motives behind the observation, a different set of outcomes may ensue. If, for instance, employees reason that their increased productivity could harm their fellow workers or adversely impact their earnings eventually, they may not be actuated to improve their performance. Participants in a dementia trial were randomised to intensive follow-up (with comprehensive assessment visits at baseline and two, four and six months post randomisation) or minimal follow-up (with an abbreviated assessment at baseline and a full assessment at six months).

Primary care patients, playing an active role in the patient–doctor relationship, were more prone to the HE than more passive patients in a hospital setting. The HE was less pronounced in deprived dwellings, possibly increasing health inequalities (66). The narrative results regarding the definition of the HE have been summarized in Supplementary Table 1 with the description of the study, definition the authors used and a quality appraisal. There have been many replication studies aimed at proving or disproving the presence of the Hawthorne Effect.

Perhaps, this is not at all surprising, although it does undermine further the idea that there is a single effect, which can be called the Hawthorne effect. It is noteworthy that the three other studies with health professionals, all using control groups, show no effects [28,37,39]. Up until recently, the HE has mainly been linked with observation bias, though the interaction between observation and selection bias has already been described (14, 67). To this point, the use of the term “Hawthorne effect” was of little interest as it was considered to be limited to the fact of observing a subject or an investigator in an experimental environment. The various publications of McCambridge have created a new association with social desirability bias and conformity bias (15, 99, 100). After having completed this review, we acknowledge the reality of what we chose to continue calling the Hawthorne effect, not only as an observation bias or as a summation of biases but also as a complex system that more or less creates an artifact in all research.

In the work groups of these experiments, the socialization was dependent upon the interactions amongst the workers and between their superiors and themselves. The workers also created their own norms of production, reflecting a kind of socialization where each worker realizes the limits of their coworkers and come to a mutual agreement concerning when they have produced enough work that day. These norms were rarely violated even in the face of financial incentive; the workers together acted as one part of a whole. Like the Hawthorne effect, the definition of the Hawthorne experiments also varies.

The first and most influential of these studies is known as the “Illumination Experiment”, conducted between 1924 and 1927 (sponsored by the National Research Council). The Hawthorne Experiments, conducted at Western Electric’s Hawthorne plant in the 1920s and 30s, fundamentally influenced management theories. Ayesh Perera, a Harvard graduate, has worked as a researcher in psychology and neuroscience under Dr. Kevin Majeres at Harvard Medical School.

1. GP investigators gave their consent for this transformation without participating in it.
2. This goes to show that while the Hawthorne Effect has been a part of productivity and human behavior studies, it could also affect the results of studies in the medical world.
3. This state of affairs points toward an obvious need for further study of whether, when, how, how much, and for whom research participation may impact on behavior or other study outcomes.
4. Observation may become a variable of its own that researchers have to account for when setting up or conducting a study.
5. Although we have sought to make our explorations of the heterogeneity of included studies as informative as possible, our analyses might be seen as excessive data fishing.

Like other types of research bias, the Hawthorne effect often occurs in observational and experimental study designs in fields like medicine, organizational psychology, and education. It’s named after a study at the Hawthorne Works factory, where researchers found that workers became more productive when they realized they were being observed, regardless of the actual working conditions. They carried out their experiment on 14 men who assembled telephone switching equipment. The men were placed in a room along with a full-time observer who would record all that transpired. Indeed, lead researcher Elton Mayo — in contrast to the authoritarian view of ideal management — concluded that job satisfaction increased when workers had the freedom to decide on output standards and their ideal worker conditions and were able to collaborate.

In HH studies, it was estimated to take 14 min after the appearance of the observer before health professionals altered their hand-washing behavior, increasing further after 50 min (71). In sleep agendas for sleeping trouble, there was a significant improvement in sleeping duration between the baseline measure and the measure at randomization; insulin resistance and fasting glucose improved simultaneously (28). In chronic kidney disease, there was an improvement in the glomerular filtration rate during the 3-month run-in phase of an RCT, in a disease where this usually worsens over time (50). In neck pain, the intensity of the pain diminished between screening and randomization (43). The same two researchers independently appraised the risk of bias and the level of evidence during the review of the selected full-text reports using the Cochrane tool (19). A study from the  American College of Rheumatology showed that the Hawthorne Effect may have played a role in the results of a study on rheumatoid arthritis.

Hawthorne Effect

In the 1970s, a study aimed to see whether or not a treatment would reduce motor dysfunction in patients with cerebral palsy. The researchers recorded testimony from the patients about the result of the treatment and quantitative data based on different tests. The patients said that the treatment worked for them, but the results from the tests showed otherwise. This could support the idea that motives, the demand effect, and the compliance bias could all play into the results of a study.

On the one hand, letting employees know that they are being observed may engender a sense of accountability. The studies discussed above reveal much about the dynamic relationship between productivity and observation. Following the secret measuring of their output for two weeks, the women were moved to a special experiment room. The experiment room, which they would occupy for the rest of the study, had a supervisor who discussed various changes to their work. In a separate study conducted between 1927 and 1932, six women working together to assemble telephone relays were observed (Harvard Business School, Historical Collections).

Other explanations of the Hawthorne effect

The use of the term “Hawthorne effect” in health sciences is gradually increasing though its definition remains unclear. It is still more often used without any connection to the original studies in the Hawthorne plant, with a meaning of alteration of behavior related to an experimental background. In other disciplines, its meaning has mutated over time to become still more controversial (15). As our purpose was to investigate the HE in primary care research, we limited our investigations to medical research and our information sources to Medline and to the reference lists of the reviews. We hypothesized that the research in the reference lists of the reviews would provide any material that we would have missed by not exploring other sources. Besides this, PsycINFO and the Web of Science were searched to discuss the results.

Persons who feel guilty about breaking the rules in light of the norms of their social group (e.g., screening secretly for cervical cancer) will refuse the interview due to shame or fear of being discovered, or may not be willing to go further into transgression. To compute the size of the HE, we purposely selected fifteen studies with different designs where the HE was appraised by different approaches (see study characteristics and Supplementary Table 2). No ethical statement is required in France for systematic reviews reusing already published data (research method classification MR-004). This phenomenon became known as the Hawthorne Effect, named after the Hawthorne Works electric factory where the studies were conducted.

Why It’s Important to Know About the Hawthorne Effect

Many other co-founding factors existed, including the financial incentives of better payment and more individual accountability and the effect of continuous performance feedback. The test-room women were paid an at-the-time seemingly astronomical amount, and earnings was among https://1investing.in/ the top three cited reasons why these women preferred the test room over the usual working conditions, with financial incentives functioning as a clear source of motivation. When the Hawthorne studies ended in 1932, more than 20,000 employees had participated in some way.

For this reason, we only searched reports related to the medical field and we limited our search to Medline and the reference lists of the review articles that we retrieved. This choice might have been too specific and for this reason, we deepened our search using PsycINFO and the Web of Science in order to enlarge the consideration of the results in the discussion. The search in reference lists and other sources found, with two exceptions of reports that were considered in this review, records deriving from other disciplines, mainly from psychology hawthorne experiment definition and education sciences. Considering the important number of reports that we analyzed and the definitions that were verified, the risk of having missed a definition due to a too-specific search seems minimal. As explained above, we only considered the appraisals of the effect on binary outcomes made in primary care research, outpatient clinics, and persons in good health (students) for the calculation of the size of the HE. Hand-hygiene studies were ruled out of our research since Purssell et al. published their meta-analysis (17).

Selection process

To minimise the chances that any difference was due to medication intake, the minimal follow-up group was sent their study medication by post (Royal Mail) at two-monthly intervals. CB designed the study, searched, selected, and analyzed the published reports, conducted the meta-analysis, and wrote the manuscript. CC copyedited and revised critically the reports for important intellectual content. LP and PV supervised the design of the study and revised critically the manuscript for important intellectual content. All authors gave their final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.