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How surveillance cameras can improve medical care

The Get Out Clause put together a music video in 2008 by performing in front of 80 different surveillance cameras.

As the video released Thursday of the two suspects in the Boston Marathon bombings make clear, the surveillance video camera is now a ubiquitous part of our lives.

Of course, it’s been that way for some time now, particularly overseas. China reportedly installed 10 million surveillance cameras in 2010 alone. And in Great Britain, the devices are so prevalent that a strapped-for-cash British band put together a music video in 2008 by performing in front of 80 different surveillance cameras and then requesting the video footage through the U.K.’s Freedom of Information Act. (They were able to get footage from only 20 of the cameras.)

Still, I was surprised to read in an essay published online Thursday in the Journal of the American Medical Association (JAMA) of how hospitals are using surveillance cameras, sometimes surreptitiously, to get their medical staff to improve care. And the cameras seem to work remarkably well for this purpose. For once the doctors and nurses knew they were being recorded, the quality of their care got significantly better.

Here are two examples from the essay, which was written by Dr. Martin Makary, a surgeon at Johns Hopkins University in Baltimore, Md.:

At Long Island’s North Shore University Hospital, hand washing compliance rates were consistently low [among staff] despite educational efforts. In response to those low rates, the hospital took an assertive approach to solving the problem by installing cameras to monitor hand washing rates. The outcome data were reported to the staff and as a result, compliance increased from 6.5% to 81.6%, demonstrating the potential power of this technology in the medical setting. …

At Indiana University, [researchers] decided to use the recording feature of colonoscopy video equipment to address the long-standing problem of quality variations in colonoscopies. Over several months, the investigators performed a blinded review of 98 colonoscopy videos performed by 7 gastroenterologists who were unaware that their procedures were being recorded. Procedure quality scores and mucosal inspection time data were collected based on established criteria. Wide variations in quality were found. The researchers then informed the gastroenterologists that their procedures were being video recorded and peer reviewed. Following the announcement, mean inspection time during colonoscopy increased by 49% and quality of mucosal inspection improved by 31%, suggesting a substantial improvement in quality.

Several benefits

In his essay, Makary argues that all appropriate hospital procedures should be video recorded — with the patient’s approval, of course. Doing so, he says, would help dissuade physicians from performing unnecessary medical care, which is estimated to account for as much as a third of U.S. healthcare costs. He also believes that the videos would provide a more accurate record than written notes of what happened during the surgical procedure — information that could be valuable later in the patient’s care.

In addition, video recordings might help quash what Makary calls “the chronic problem of disruptive behavior in medicine.” He cites a 2005 survey involving 50 hospitals that found 86 percent of nurses and 47 percent of physicians had witnessed disruptive behavior by other nurses and physicians. (Such behavior includes outbursts of anger, intimidating or demeaning behavior, and “passive actions,” such as refusal to cooperative with other medical professionals or to perform assigned tasks.)

‘A broader spirit of transparency’

Surveys have shown that patients like the idea of having their surgeries videotaped. “In one study in which 248 patients were asked if they would be interested in receiving a video of their procedure, 81% said yes and 61% were willing to pay for it,” writes Mackary.

“Sharing videos with patients may be associated with improved patient satisfaction because doing so embodies a broader spirit of medical transparency,” he adds.

Doctors and hospitals may not be as enthusiastic about that transparency, of course, because of the risk that the videos might be misused in malpractice claims. Makary, however, believes that this concern is overblown.

“The adoption of video recording to improve quality and safety should be more widely implemented,” he says. “Based on early observations, this approach also could help drive quality improvement to the next level.”

You can read Makary’s essay in full on the JAMA website.

Comments (2)

  1. Submitted by joel gingery on 04/19/2013 - 02:18 pm.

    This Conversation May Be Monitored for Quality Assurance Purpose

    Simply putting more video cameras in hospitals is unlikely to improve people’s well being. Here are two examples of recent monitoring programs in education that illustrate a this point: and: Monitoring simply creates a goal or target that workers, including professionals, will, if necessary, cheat to meet. A worker’s performance, in either the educational and/or healthcare system, is determined by the way the system is organized, its purpose. Ask yourself, “What is the purpose of healthcare?” Now compare your answer with the actual purpose of health insurance companies, hospitals, etc. This ‘achievement gap’ is the significant one, and points the way toward better healthcare. Homework assignment: compare what you believe to be the purpose of education vs what the educational system actually does.

  2. Submitted by joel gingery on 04/20/2013 - 06:32 am.

    Gaming the (Disruptive) System

    Harvard Business School professor Clayton Christiansen, ( author of “The Innovator’s Dilemma, When New Technologies Cause Great Firms to Fail,” ( talks about measures of success:
    ” S+B: You’ve said that metrics like the internal rate of return (IRR) and return on net assets (RONA) lead to shortsighted decisions. What would be better measures?
    CHRISTENSEN: The answer probably depends on where you are in the cycle of a business. What you measure has a huge impact on what people prioritize—in fact, whatever you measure will put into place a way for people to game the system. Therefore, you’d better pick a measurement that causes people to do good things when they try to game the system.

    “For instance, integrated steel companies used net profit per ton to measure their performance in the 1980s. This led them to want to get out of the low, commodity-based end of steel production, because volume at the low end makes it harder to get dollars per ton up. That decision made them vulnerable to the mini-mills. It turns out that most managers don’t even think about where their measurements come from. You can ask executives, “Who decided to measure net profit per ton?” They’ll scratch their heads and say they don’t know. It’s as if somehow the measure came from the sky. And it causes them to do crazy things.”

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