Writing the Wrongs
Patient safety
Issue 47 | June 2018
Agency
The PatientSafe Network and Host/Havas
Creative Team
Anaesthetists Dr Robert Hackett, Dr Rhys Thomas, Dr Zoe Burton, Dr Gordon French, Dr Sethina Watson, Dr Matt Turner Student Midwife Alison Brindle Nurse Jo Lever Richard Midwifes Danielle Carey, Jenny the MSurgeons Dr Liz O’Riordan, Dr Peter Brennan Executive Creative Director Ant Melder #hellomynameis Chris Pointon
Production Team
Head of broadcast & print production Monique Pardavi Editor Beau Williams Producer Andrew Perry Senior Designers Frank Molina, Nic Adamovich ECD Seamus Higgins
Date
2018 ongoing
Background
It was reported by the British Medical Journal that medical error was the third biggest cause of death, after heart disease and stroke. And WHO data showed that communication errors caused almost 70% of adverse events in hospitals. Issues were often caused and exacerbated by the fact that medical staff worked in multiple hospitals with many different colleagues, so they didn't know or remember each other's names.
When communication in operating theatres was not clear and immediate, mistakes were made and seconds lost.
Idea
As is so often the case, the answer to what seemed a complex problem was ridiculously simple. A group of doctors and other medical staff began writing their names and job roles on their scrub caps. It was an act which changed the culture of the theatre from anonymous and potentially inefficient to collaborative and accountable.
The idea started off at a grass roots level, spreading through word of mouth. It was pushed out across social media via #TheatreCapChallenge, engaging front-line medical staff and encouraging them to take up the new behaviour. Medical staff all over the world embraced it and some began having bespoke hats made. Scrub cap manufacturers came on board and started offering personalised hat printing and designs. PR coverage helped the idea spread despite $0 and 0 years of research and development. Going forward, medical and political leaders are being lobbied to make name/role hats mandatory in operating theatres.
Results
The idea has been implemented by front- line medical staff in Australia, UK, USA, Spain, Portugal, Russia, China, Korea, South America and Africa and has been supported by leading medical bodies including the Royal Australian College of Surgeons, the Royal College of Surgeons and the Australian and New Zealand College of Anaesthetists.
Total media impressions: 95,370,616 Total value of earned media: $35,322,450 The Sydney Morning Herald piece was read by more than a million people on one day gaining over 300,000 likes and over 30,000 comments.
Our Thoughts
Two rather marvellously analogue solutions to major problems in modern hospitals (see ‘Knockout Infections’ on pages 62-63)
I’m reminded of the story about NASA in the 1960s. They couldn’t get their pens to work in zero gravity so they spent a lot of money developing pens that would pump ink in space. The Russians used pencils. This is similar. Faced with the problem of improving communications in theatre, my guess is nine out of ten people in the communications industry would have looked for a smart digital solution. Beacons, apps, connected clothing, that sort of thing. But a creatively-minded doctor saw the answer lay with a marker pen. So brilliantly analogue.
The agency’s contribution has been to take the idea and get it out to hospitals around the world.