STOP THERE The ability to call time out in the OR was an important first step. Remote video auditing gives the practice real teeth.

If hand hygiene compliance at your facility isn't what it should be — and chances are, it isn't — read on. By taking video monitoring to the next level, we've seen hand-washing rates shoot up from less than 10% to around 90%. We realized that it's one thing to have cameras installed in your facility — people are used to that. It's a whole new ball game when you have people actually monitor and report on what happens (and what doesn't) in your facility. It might sound exorbitant, but it's paying off, in improved hand hygiene and in several other ways.

Improved hygiene
The breakthrough happened when one of our partners, North Shore University Hospital in Manhasset, N.Y., was having trouble with hand hygiene compliance, despite concerted efforts. When they had cameras installed throughout the ICU to record when staff washed their hands, they assumed compliance would be around 60%. Shockingly, during a 16-week preliminary period in which staff were filmed but not given results, rates were actually less than 10%. Lesson learned: Simply installing cameras didn't change behaviors.

But after we started monitoring and collecting data, and then streaming scores — without mentioning any names — on wall-mounted digital scoreboards, compliance quickly zoomed to nearly 90%. Now, scores for each shift are broadcast on hallway scoreboards that flash "Great Shift" when staff compliance tops 90%. That's a real motivator.

Another partner, Forest Hills Hospital in Queens, N.Y., also wanted to see whether video monitoring could improve how the ORs were cleaned between procedures. There are 10 items on the cleaning checklist — miss one, and you fail. Before they started monitoring, they were a complete bust, achieving perfect compliance 0% of the time. Now they're close to 100% in that area, too.

Monitoring also ensures that overnight cleaning processes are followed, another important factor in reducing the risk of surgical site infections. Terminal cleaning compliance has improved to almost 100%. The hand-washing program helped us learn a powerful lesson: People change behaviors when they know they're being monitored and they see the results of compliance.

Hold everything
From there, we've recently expanded the program to improve on the surgical time out program we rolled out in 2008. The idea at the time was to systematically cover all procedures related to the OR, with a special focus on preventing wrong-site surgeries. Unfortunately, the time outs didn't succeed the way we hoped they would, so we began looking for better ways to motivate staff and improve compliance.

Two breakthroughs made the difference. One was identifying the anesthesiologist as the logical candidate to take leadership in implementing time outs. The other was auditing video. When we did those things, compliance with time out procedures almost immediately shot up to nearly 100%.

More big brotherly than Big Brother
Arrowsight, the company that does our monitoring, has staff on duty 7 days a week, 24 hours a day, at various offsite facilities. That's important because there's no added burden for our already-busy hospital staff. Another key to success: We're concentrating on teamwork; as noted above, we're not looking to single out individuals for non-compliance. In fact, when we see the video, faces are blurred out, so we can't tell who's who. Plus, the auditors aggregate all data and hospital leaders see only the aggregate, never the raw data. Finally, all data is destroyed within 24 hours.

The point is, we're not looking to single anyone out. What we want to see is what's happening on the floor as a whole. So if an issue exists, we can address the whole team. The data and the conversations that come from the data are what help people improve. We want people to understand and be proud when they're doing things right, and to know when they aren't. By encouraging instead of punishing them, we target their desire to do the right thing. And people, we've found, rise to the occasion.

THUMBS UP Video monitoring and the right kind of feedback made hand-washing rates zoom from 10% to almost 90%.

Substantial ROI
Studies suggest that without encouragement, hospital workers wash their hands about 30% of the time they interact with patients. Other studies suggest that hospital-acquired infections cost $30 billion a year and may lead to 100,000 patient deaths a year. Obviously, anything that improves those numbers is likely to be a good investment.

Video auditing in the OR also helps with throughput and utilization, both of which are huge issues for just about every facility, especially in the age of healthcare reform. For example, when the auditor gets a signal from the OR staff, he can send a text message that lets us know it's time to send for the next patient. That builds in objective predictability and allows for better time management. Family members know when their loved ones are going in and out of surgery, and hospital staff don't feel as if they have to work more or work faster.

Though we've just begun to get real-time feedback on improving turnover times, we've already seen sharp improvements. Previously, it took 26 minutes to get a patient into the room. Monitoring has helped drop that number to 10 minutes. Surgeons and anesthesiologists appreciate that, because it minimizes their downtime between cases. And reducing operating room turnover times can also reduce the agitation level of patients and other healthcare staff.

Along with improving patient safety, the fiscal health of the facility is also getting a boost. After all, approximately 60% of hospital revenues come from the OR. We can handle more cases each day with the time we save, and we have fewer overtime costs resulting from delayed surgeries. Given that the average cost for OR usage is $2,000 per room, per hour, it's easy to see that the benefits and cost savings can be huge.

How convinced are we that this is an innovation that provides value to patients and staff? We're currently expanding our program by adding video auditing to 20 more ORs in our system.