Real Stories from the Streets of Healthcare!
Martine Ehrenclou, MA and Beth Boynton, RN, MS
With patients and healthcare professionals all too often on opposite sides of the table, our goal is to bridge that gap. As a patient/patient advocate and registered nurse, Real Stories From the Streets of Healthcare is our way of discussing real stories and issues that involve patients and families, nurses, other healthcare professionals, and the healthcare environment itself. We plan to look behind the closed door, break down walls of silence, and tackle thorny issues to increase understanding of the complex healthcare problems we all face. See our welcome page for more information about our blog duets here.
Below is our second duet.
Will Cameras in the OR Improve Patient Safety?
The incidence of surgically related sentinel events, (or patient safety events) tracked by the Joint
Commission is consistently high and there are three types that are in the top ten list of those most frequently reviewed;
- wrong-patient, wrong-site, wrong-procedure
- unintended retention of foreign body
- Op/post-op complication
This has been true since the Joint Commission began tracking data in 2014.
So when I received a request to sign a petition to mandate cameras in the OR I felt compelled to look at it closely. I also felt torn.
On one hand putting cameras in OR seems like it might make the OR team more accountable for doing things properly and making sure they have the right patient, maintain sterile technique, and do not leave any foreign objects behind. A level of accountability that cameras might indeed positively impact.
My hesitancy comes from worries about what the underlying problems are. I worry that the underlying human dynamics going on are a primary problem and that we should do the work required to ensure that the team and organizational culture are safe, just, and respectful and that the surgeons and OR nurses and techs are practicing effective communication first. If we put cameras in an operating room where there is bullying and blaming, what will cameras do? They may stop overt mistakes, but those dynamics will not go away and are likely to surface in other creative (or destructive ways). Maybe staff turnover would increase, (there is a steep learning curve for OR nurses) or last minute cancellations of surgery would become a frequent problem leading to delays in treatment and added stress, or there would be more documentation errors leading to loss of revenue, or maybe a patient’s surgical procedure would end up on Facebook. I’m just guessing, but my sense of human nature is that if we don’t build healthy relationships, the negativity will ripple out somewhere. Plus, I can’t imagine wanting to work in an environment of such close supervision unless there is a positive team dynamic.
This blogpost provides a little more info about the dynamics in the OR and some interesting similarities between the US and UK.
I think fixing the underlying problems and THEN putting cameras in the OR along with policies and protocols for ensuring privacy and being clear about use of recordings, i.e. to monitor standard operating procedures are followed and perhaps teaching.
What are your thoughts?
I too feel torn about putting cameras in the OR. For one, I don’t like the idea of cameras everywhere and they do seem to be in all sorts of places. Entire cities in the U.S. have surveillance to watch residents in an effort to catch terrorists, to prevent vandalism at parks and other locations, catch drivers who run through red lights, and more. There seems to be a big push for the police to wear body cams. According to a report by the Department of Justice, “both officers and civilians acted in a more positive manner when they were aware that a camera was present.”
As you pointed out, the number of sentinel events related to surgery is very high. For those who don’t know, a sentinel event results in a patient’s death, permanent harm or severe temporary harm and intervention to sustain life. You gave good reasons to support cameras in the OR in effort to make the surgical team more accountable. That just might make patients safer.
I think of the Dallas, TX, anesthesiologist who was supposed to be minding the patient during surgery but instead was texting and reading on his iPad. The patient died. It would seem that cameras in the OR would halt this type of behavior.
However, I also believe that cameras in the OR would only initially stop preventable medical errors. As we’ve witnessed on reality TV shows, the camera is soon forgotten.
You bring up some very valid concerns about real underlying problems with bullying and disrespectful behavior among surgical staff and how a camera in the OR might affect how those behaviors play out if the issues aren’t addressed first. As you suggested, bullying and blaming might just surface in other insidious ways outside of the OR. I agree with you that a camera won’t build healthy working relationships if the root cause isn’t taken care of first. In fact, I could see further destructive problems arising as a result of cameras in the OR. If a video catches a surgical staff member committing a medical error and it is circulated maliciously, that could end careers and cause emotional devastation.
You also brought up the frightening risk of patients’ surgeries being posted on Facebook. If it hasn’t happened already, surely it would.
However, I believe that patient safety must come first. As much as I don’t like the idea of cameras in the OR, I wonder if they wouldn’t force healthcare professionals to pay more attention to which part of the body is operated on, to the count of sponges after surgery to make sure none are left inside the patient’s body, or if an instrument used in the surgical process is accounted for or accidentally left beneath the sutures.
I keep going back to the same idea—if there had been a video camera in the the surgical suite where Joan Rivers lay asleep on the operating table, would her doctor still have taken a Selfie with her while she was lying there completely unaware? Probably not.
Wholeheartedly, I agree with you that the underlying problems need to be fixed. But I wonder how long that will take. I wonder how long patients and their families can wait.
Excellent and provocative points, Martine. The idea that a surgeon would take a ‘selfie’ with Joan Rivers lying there vulnerable is so disturbing. And bizarre if you consider the idea that it is a camera that would (or at least, might) have prevented him from honoring a boundary that he was using a camera to break! Where was his sense of professionalism and respect for the patient and their therapeutic relationship? And how would his inappropriate thinking and behavior manifested if he didn’t take the picture? What need was he trying to meet?
Thank you for the Department of Justice report and your comments. I find the ‘cameras everywhere’ to be a disturbing phenomenon. Is this is a symptom of a world that is spinning out of control? It raises so many questions about individual accountability, leadership, and privacy. ‘We’ seem desperate to control things rather than creating platforms from which they can emerge healthily. Maybe we need to do both in the world we are currently living in.
I am clear that I need to be assured that effective efforts to address interpersonal dynamics, organizational culture, and professional boundaries are in place and ongoing in order to advocate for cameras in the OR. And I’m not talking about putting up signs that say “Professionals must behave respectfully”, or “ABC Hospital Maintains a Zero Tolerance for Bullying” but rather experiential learning techniques that develop people skills and emotionally mature behavior such as Crew Resource Management, TeamSTEPPS, and Medical Improv while creating safe and just cultures that support healthy dynamics and collaborative. These take time and effort, but aren’t impossible and there are many opportunities to be doing this all along the course of doctors and nurses’ education and careers. IF we are willing to make it a priority.
Patients do deserve the best we have to offer and shouldn’t have to wait.