An Unpleasant Metaphor helps Explain Concerns about Cameras in the Operating Room

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I remember walking in patient’s room not long ago when working on a secure dementia unit.  The smell of urine was strong and she was putting on a clean pair of depends.  A good idea, really, but the problem was she wasn’t taking off the old pair or cleaning herself.

I’ve received several invitations to sign a petition to put camera’s in operating rooms, but I just can’t do it.  I can understand the reasoning and passion for OR team surgerycreating the campaign especially from those who have been harmed from surgically-related sentinel events.  Maybe cameras would help by making the OR team accountable for following protocols and behaving professionally.  Surely both would be good, right?

I think we need to fix the underlying problem(s) first!  Toxic cultures and workplace violence are contributing to poor communication and ineffective collaboration that lead to mistakes.

The statistics re: errors and surgery are compelling, persistent, and well documented as are the links to communication and people skills.  Here are a few blogposts  re: the topic with links to resources.

If we don’t make sure that teams are healthy first which can be done with processes like TeamSTEPPS Crew Resource Management, Whole Systems consulting and Medical Improvsymptoms of these problems will show up somewhere e.g.: pre-op processes and scheduling, recovery room, and recruitment and retention.

Qui81px-Avicamte frankly, unless I’m feeling a strong sense of organizational support and professionalism with my colleagues, the idea of being recorded all day is enough to make me think twice about working in such an environment.

So with all due respect to the people who are leading this campaign and a genuine interest in addressing the same problems, I am not signing the petition. However, amend it with a caveat to address these concerns first and I will reconsider!

You can learn more about the campaign here:

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10 Responses to An Unpleasant Metaphor helps Explain Concerns about Cameras in the Operating Room

  1. Danny Long says:

    Petition text revision 1

    Target: Elected officials who are involved in legislation requiring cameras in operating rooms to reduce harm, and learn from errors..
    Medical errors are now the #3 cause of death in America. Over %10 of patients die after leaving surgery, largely due to behavior in the operating room.

    2004 The Joint Commission mandated basic surgery protocols. A decade latter, enforcing those mandates remains spotty at best, preventable patient harm and death continue largely unabated.
    One of the prevailing causes is described as “disruptive behavior” by some providers.

    In 2008 The Joint Commission then issued A Sentinel event Alert. It included a “Zero tolerance” for intimidating and/or disruptive behaviors”

    2014 Joint Commission Root Cause analysis
    Top three failures, Leadership, Communication, Human factors.

    2015 Hospital culture remains toxic for many providers today, patient harm remains at unacceptable rate. No where else is a patient more vulnerable than on the operating room table.
    Waiting for hospital administration to address the culture of healthcare has proven an abysmal failure
    .
    We now have a clear moral responsibility to mandate cameras inside our operating rooms not only enforce safe surgery protocols, but improve outcomes, communications, learn best practices, sharpen skills, but mostly finally address the over-all culture (human behavior) inside our hospitals that administrators ignore.
    The toxic culture simply can not be permitted to continue, cameras are mandated.

    • NIMBY w/Purpose says:

      Hi Danny,
      I applaud what you are doing as well, but-as someone who has worked in operating rooms with and without cameras, I can guarantee that this is not going to make a difference because the pressure to ‘perform’ is not in the surgeon mindset during the moment. Not only that, but there are protections in place that protect the video from being subpoenaed and used in court situations. They are only used for peer training purposes. Yes, you are right in that this helps them to learn, and after having sat through countless simulations and watching them critique and review one another’s performance, at the moment that the real thing is happening, the cameras become irrelevant. I am so sorry for everything you have been through…and you are right. Behavior is not to be tolerated. But until it can become safe for a nurse to speak up and say something to the surgeon, anesthesiologist or another nurse who is doing something incorrectly, the camera is not what will stop it.

      • Danny Long says:

        Hi NIMBY?

        I am fully aware of the toxic environment of hospitals, the terror of just working among arrogant, co workers, the intimidation, etc.. well documented.. yet.. change.. not so much..

        Thousands of families are being ripped apart every single day out here.. . Knowing the same harm is being caused repeatedly daily, year after year across America.. is no longer tolerable. It is just too much.. the betrayal of the american peoples trust simply is no longer acceptable… Lie Deny and Defend was, and always has been destined to blow up in the face of hospitals..

        Protecting egos, and hospital profits has cost patients billions of dollars in life savings, millions of families torn apart, millions of permanently crippled victims..

        The wicked problem caused by corporate medicine is now in our lap, yours and mine. Wait until .. wait until.. has not worked, the civil and criminal system has not worked, nothing has worked to tame this wicked beast…

        Playing nice has failed miserably.. waiting is nothing more than condoning 🙁 my friend on the inside

        • Beth_Boynton_RN_MS says:

          Thank you both for your comments, Nimby and Danny. I’ve been following/discussing related threads on LInkedIn as well. Although cameras seem like they would help prevent errors and increase accountability, like the metaphor in my post, are not the answer without process-oriented work to address human factors. Maybe we should work on a petition for that? I’d be willing to work on one with you Danny. One of the tricky parts is that a petition tends to be control oriented and what we need are processes that will set the stage for healthy teamwork to emerge. Like a basketball game, people are ‘performing’ because they’ve practiced and practiced but the game itself emerges in the moment and the action is unpredictable and spontaneous. One of the reasons I am so persistent about ‘medical improv’ is that it builds trust, skills and relationships necessary so in-the-moment work together will arise not only out of expertise in the work but also trust and respect. In cultures where trust and respect exist the cameras may be great teaching tools, but in cultures where these things aren’t present, I don’t believe they would solve the problem. LIke checklists, if the underlying dynamic isn’t addressed, they (IMHO) are not going to function as the same tools. This post helps explain that and may be useful in teasing out this issue: http://www.confidentvoices.com/2012/12/28/questioning-why-checklists-work-to-optimize-their-use-in-patient-safety-interventions/

          • Danny Long says:

            I am on-board with all of this.. ending silence with silence.. not likely.. It is past time to raise a ruckus, a bodacious ruckus..

            I have a clear picture of the ugly truth inside hospitals that corporate medicine has spawned.. More often than not, corporate philosophy has drawn out the worst in humanity.. We are now dealing with a wicked problem that can easily be traced all the way from bed-side, to hospital board rooms, medical boards, state government, federal government, mainstream media has also played a pivotal roll in creation, and perpetuation of this wicked problem.

            Cameras.. well simply put they are as much a part of our culture as the Big Mac, french fries, and a coke. Near the end of the Viet Nam war, it was these videos on TV that showed the real suffering of that war.. It changed public views… (Sadly those days when TV still held a shred of credibility are now long gone)

            Comparing what we now face with American Solderer death toll?

            Roughly 55,000 American military died in the (roughly) years of that war.. <- remember, the enemy's intent was to kill Americans.

            Today (roughly) 55,000 loose their life needlessly by the very industry paid NOT to harm, but help.

            Media, silent at best, miss information at worst to keep the suffering covered up.

            2014, less than 10% of Americans have a clue about medical care problems..

            So, no matter the "effort" it simply must first move the public pressure needle up closer to 50% or we are simply preaching to the choir.

            Much love and understanding to those inside caught in this wicked beast..

            At least your still alive to speak out for those out here who are not so lucky..millions..

            Please remember, we even have victims in wheelchairs out here, unable to care for their own basic bodily functions, crippled for life.. Who have the courage to speak up..

            Hence, decades of frustration.

            It is time to raise a ruckus, a bodacious ruckus.

            http://altarum.org/sites/default/files/uploaded-related-files/Fall_2014_Survey_of_Consumer_Health_Care_Opinions_Final.pdf

  2. Danny Long says:

    Petition text revision 1

    Target: Elected officials who are involved in legislation requiring cameras in operating rooms to reduce harm, and learn from errors..

    Medical errors are now the #3 cause of death in America. Over %10 of patients die after leaving surgery, largely due to behavior in the operating room.

    2004 The Joint Commission mandated basic surgery protocols. A decade latter, enforcing those mandates remains spotty at best, preventable patient harm and death continue largely unabated.

    One of the prevailing causes is described as “disruptive behavior” by some providers. In 2008 The Joint Commission then issued Behaviors that undermine a culture of safety A Sentinel event Alert. It included a “Zero tolerance” for intimidating and/or disruptive behaviors”

    2014 Joint Commission Root Cause Information for Wrong-patient, Wrong site, Wrong-procedure Events
    Top three causes, Leadership, Communication, Human factors.

    2015 Hospital culture remains toxic for many providers today, patient harm remains at unacceptable rate. Disruptive behavior including bullying and intimidation remain a prevailing problem in hospitals. No where else is a patient more vulnerable than on the operating room table. Waiting for hospital administration to address the culture of healthcare has proven an abysmal failure.

    There is now a clear moral mandate to put cameras inside our operating rooms not only enforce safe surgery protocols, improve outcome, communications, learn best practices, sharpen skills, but mostly finally address the over-all culture (human behavior) inside our hospitals.

    The toxic culture simply can not be permitted to continue.
    .

  3. Danny Long says:

    Beth, I want to tip my hat to you in reaching out here in this format!
    I more than welcome to opportunity you have been so gracious to extend to myself and so many others.. This is exactly what is needed.. “Open air conversations”. I also applaud you and your dedication to addressing the toxic environment healthcare workers endure to care for the most vulnerable.
    I am totally 110% agree, I’m on-board with you Beth that “Bullying, it is a huge, and ugly, ugly reality at the root of the problem of hospital culture.”

    Quick introduction: My name is Danny long, the creator of the petition discussed here to put cameras in our operating rooms to ensure basic safe surgery protocols are followed, not ignored.

    Briefly,
    I am not an educated man, I live by the more basic logic, barn yard approach to problems in life.

    The petition we are discussing is just one of the efforts of over a half decade journey into the medical harm problem as a whole.
    You see on 7/28/08 my wife walked into a renowned medical university for elective surgery I brought her home 51 days latter in her own car.
    She will never to be able to care for her own basic human functions, let alone walk. She requires 24/7 care the rest of her life. Needles to say the renowned medical universities response was, and remains a nightmare it’s self. The records of surgery clearly point to total chaos, absence of concern for even the basics. Post-op records clearly point to intent.. I will leave it at that.
    We both became immediately unemployed, I became her 24/7 care giver, we lost our life savings, and now struggle to keep the modest home we had just completed building with our own two hands, all while we both worked full time jobs.

    But this petition is not about me, or my wife, or any single patient or provider.. it is about the moral imperative we all simply must address.The culture of healthcare is producing the staggering amount of needless human suffering and bankruptcies. We can also see this toxic effects in medical school students graduating suicidal at a much higher rate than their non medical school counterparts.

    As far as what to address first.
    All too often it seams like the chicken or the egg.. (symptom or cause) or. .. No my issue is bigger than yours, or, It’s political, or, money/profit, or it’s big pharma, or Obomacare, bla bla bla.

    As I said earlier: : I am totally 110% agree, I’m on-board with you Beth that “Bullying, it is a huge, and ugly, ugly reality at the root of the problem of hospital culture.”

    My fear is the debate over “symptom or cause” will continue to be a huge anchor keeping our hospitals locked in decline.

    Making sure all actors are giving the very best performance prior to turning on the cameras may just propagate the “current status quo” we ALL despise. Camera;s have proven time and time again to be the single most effective tool in the box.

    I welcome others opinions..

    Thank you
    Danny and Shelly

    • Beth_Boynton_RN_MS says:

      Hi Danny,
      Thank you so much for sharing your story and I am so very sorry about your wife’s experience and the loss you have both incurred and continue to suffer from. You make some great points and I appreciate your awareness of bullying and toxic cultures. I would feel much more comfortable signing a petition that qualified the need to address these issues before or in conjunction with putting cameras in ORs. The combination, I believe will better serve all of us.

What are your thoughts?