They have people constantly monitoring hospitals, unlike in restaurants which is every few months at most. My job was to walk around all day to make sure people are washing their hands before and after putting gloves on for 20 seconds with warm soapy water. I had to make sure they didn't see me and no one knew what I was doing. I was surprised to find that although most did wash their hands at the right times, they didn't really make sure they lathered correctly and it was very rarely 20 seconds by the nurses, more common for doctors to do it right though, although some doctors did not either.
I'm not sure how much actually gets reported correctly though and how strict the supervisors are, employees are likely to get away with a lot things, it's not easy to hide all the time and it's easy to miss things.
