> But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals.

I think it's more likely that there is an immediate feedback loop to disregarding the checklist (i.e. the plane crashes and the pilot dies), whereas not washing your hands has a lot more delayed consequences in which the causation isn't readily known. I think this is the general problem with Outcomes Based Health - we have the stats to back up its effectiveness, but don't have the immediate feedback loops to promote it.