NAPA

Peter H. Doerner

The good news is that since 2008 there has been a promising ways to build a safety-measures in hospitals with the help of third-party “remote video auditing” technology—a positive behavior modification strategy delivering real-time feedback to operating room teams. The results have been compelling not only in pilot studies in the early years but now with ongoing success at major hospitals and health systems around the country that have implemented this process. Using this process along with training protocols, results include nearly 100 percent daily compliance with the surgical safety checklist as well as similar compliance with hygiene and terminal room cleaning protocols, all improving infection control while boosting surgeon satisfaction and efficiency in throughput.

I had the privilege and opportunity to sit in a feature presentation at this year‘s American College of Healthcare Executives (ACHE) Annual Congress taking place in Chicago back in March. Dr. John Di Capua, (who is Vice President of Anesthesia Services at Northwell Health) and Michael Goldberg (who is the Executive Director at NorthWell’s Long Island Jewish Medical Centers tertiary campus in NY) jointly shared how this concept is making a positive difference at their Medical Center. The concept is very simple: install blinded cameras in each operating room monitored by trained external non-clinical staff remotely and share actual real-time metrics for each operating room every two minutes every day of the year. Those metrics are then shared on display boards outside the operating rooms, on staff and physician’s handheld devices, in recovery rooms, and provided at surgical committee meetings regularly. Cameras in hospitals are not new. Often they have a “Big Brother is watching” connotation. However this concept takes the idea to the next level without a Big Brother is watching mentality. In fact, since the cameras are very low resolution, they do not reveal identities but rather focus on the positions of the surgeons, anesthesiologists, and other individuals in the operating room. All teams see their results and work hard to continue those results or come together to improve upon them. The hospital’s Chair of Anesthesia is the cheerleader to drive the daily cultural change that this real-time feedback provides. The beneficiaries of this improvement in performance are the patients, surgeons, clinical staff, and other stakeholders in the patient care delivery model.

"Safety, throughput, and improvements in efficiency in our operating rooms is not just desired but required in our hospitals and ambulatory surgery centers today"

The same concept was implemented and observed at a UPMC Pennsylvania Hospital where it was documented that surgical site infections were reduced between 10 and 20 percent in a given year!

Our operating room clinical teams, by nature, want to do the best possible job for patients every day. Having this real-time feedback is one tool that has been observed to change the culture of how operating room teams work everyday.

In a report on improving patient safety and worker safety, the Joint Commission wrote at length about the importance of a safety culture describing three independent essential changes that we in healthcare organizations must undergo to become highly reliable patient organizations.

1. Leadership must commit to the goal of high reliability.
2. An organizational culture that supports high reliability must be fully implemented.
3. The tools of robust process improvement must be adopted.

The concept of remote video auditing leading to culture change on the ground becomes a tool that aligns all three of these essential changes giving hospitals and health systems a framework on which to build and measure a culture of safety. As such, the Joint Commission awarded this concept a place in its resources and quality safety network (JCRQSN) for the outstanding use of technology.

It is clear that safety, throughput, and improvements in efficiency in our operating rooms is not just desired but required in our hospitals and ambulatory surgery centers today. Society is asking us to provide high-quality care at lower cost. As a nation we can’t afford high-quality care at an escalating cost any longer. We’ve reached a point where all of us in healthcare are tasked to provide real change in a manner that supports a culture of patient safety.

When we marry technology, such as remote video auditing, with committed healthcare professionals we have a basis for true innovation that moves the needle. The above is one example that I’ve observed in recent years that is clearly hitting the mark. The question for all of us as healthcare leaders is clear. Are we ready to tackle the change of out of the box thinking or continue on the path that we’ve always been upon?