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Video transparency: a powerful tool for patient safety and quality improvement
  1. Sarah Joo1,
  2. Tim Xu1,
  3. Martin A Makary1,2
  1. 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Martin A Makary, Professor of Surgery and Health Policy & Management, Johns Hopkins University, Halsted 610, 600 N. Wolfe St, Baltimore, MD 21287, USA; mmakary1{at}

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Transparency can be a powerful driver of better healthcare quality.1 In 2013, it was proposed that recording video data in healthcare begin with the several medical procedures that are already video based (cardiac stent placement, arthroscopic surgery, colonoscopy, etc).1 Different from the past era when recording required new hardware, most of the procedures performed in medicine today are now mediated by video, enabling a new opportunity for learning health systems.2 ,3 Some hospitals, like Johns Hopkins, have even built operating rooms (ORs) equipped with cameras—some of these are used to monitor room turnover times for scheduling efficiency, while others have been installed in anticipation of a future of increased transparency.

Ever since our group first described a surgery checklist,4 compliance with the tool has been a challenge. Overdyk et al5 demonstrate the potential of using video-derived data to improve compliance rates. The authors, based at Hofstra North Shore-LIJ School of Medicine, performed a prospective study in which surgeons and other OR staff were randomised to video monitoring with real-time feedback on key patient safety activities, including compliance with the safety checklist during sign-in, time-out and sign-out procedures. They found that the feedback increased compliance dramatically and reduced OR turnaround times for scheduled cases by 14%. Moreover, these improvements were sustained throughout the feedback period. As Overdyk et al shows, video transparency is one of very few interventions in healthcare to result in immediate behaviour change around safe practices.

This is a landmark study in the rapidly expanding field of using technology to take patient safety to the next level and can be generalised to improve compliance with other established safe practices in healthcare. For years, healthcare has suffered from endemic problems associated with unwarranted variation in practice patterns, behaviours and compliance. Transparency works because …

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  • Funding Mr and Mrs John Rodda and The Rodda Family Partnership.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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