Why not examine the outliers (e.g., hospitals with superb infection control) first? Excellent infection-control policies and procedures will surely have the characteristics of an engineered technology, arising out of rapid prototyping and component-wise experimentation & debugging—all guided by substantive theorizing. (Cf. Platt’s strong inference.) This point about engineering applies quite broadly in medical science:
RCT fever has gotten the better of everyone’s common sense. Biostatistician trialists now reflexively inflate a small point about unmeasured confounding into a vast claim that threatens to swallow medical epistemology whole. Epistemically, the RCT is a desperate measure, and ought to be our last resort!
But biostatisticians may consider that they, too, have the experience of working like engineers—when they write statistical software!