Four themes emerged. Making hand hygiene part of the mantra reflects perceptions that HH culture and practice is variable across disciplines and within different parts of the facility. Shifting the balance of responsibility reflects views that introducing the concept of HH non-adherence as a healthcare error would strengthen HH programs. Innovative approaches suggested were: 1) Overdue to start using the hammer: refers to a tiered system of disciplinary action which may include financial fines and suspension from practice for repeated lapses, combined with HH education as a mandatory part of clinical reaccreditation; and 2) Role modelling and empowering all hospital staff through assertiveness training to remind and prompt each other about HH. This would be supported and sanctioned by hospital policies.