#TheatreCapChallenge: Where’s the evidence?

For those unsure that clearly displaying ones name and role will improve communication, teamwork and patient outcomes this may help:

An RCT which demonstrates that wearing hats would lead to prevention of patient deaths require over a million patients in either limb.
This is because because of the frequency of the event rate eg death from anaesthesia is so low, not because of lack of effectiveness from the intervention (see here). We need to look at other end points.

How good are doctors at introducing themselves? (see here)

Theatre staff are notoriously poor at completing the name & role part of the Team Time Out (see here)

How good are humans at remembering names?
Humans only recall 30% of names after first introduction. After introduction we are much more likely to remember someone’s profession eg baker than their name Mr Baker (see here).

We are also very poor at remembering names after we have learnt them, being much more likely to remember faces (see here).

How well do theatre staff recall names after the team brief?
25% of surgeons did not know the scrub nurses name and 30% of surgeons did not know the anaesthetists name (see here).

The surgeon only knew 44% of staff names in theatre (see here).

Communication errors have been implicated as the root cause of nearly 70% of adverse events (see here).

The number of different combinations of staff constituting the team attending a critical patient event (eg an obstetric emergency) in a single hospital can be in the 100s of millions (see here).

Knowing and recognising team members by name has been quantitatively and qualitatively associated with increased trust, work engagement and clinical improvement (see here).

Cocktail Effect
Through the use of a persons name we are able to focus them and then their attention towards a specific task (see here).

What’s in a name
Fantastic presentation by Dr Rhys Thomas – Quality & Safety Fellow John Hunter Hospital. He discusses how name badges on tops in theatre are often covered up by sterile, lead or warming gowns, how writing names on a whiteboard is often ineffectual and much more (see here).

Improved patient outcomes & recovery when their own name is used during emergence from anaesthesia (see here).

Re-usable hats may be superior to disposable bouffant hats for infection control (see here).

#TheatreCapChallenge in mainstream media
The #TheatreCapChallenge has been discussed in mainstream media internationally with write ups in Chinese, American, Russian, Japanese, Korean, Spanish and Indonesian newspapers. Over 2 days it was the most read article in the Sydney Morning Herald with over 1 million reads on one day, over 300,000 likes and 30,000 comments which were strongly supportive (see here).


If it’s the right thing to do why haven’t name & role theatre hats been readily adopted?
Cognitive dissonance (see here) Semmelweis effect (see here). Healthcare is governed by a command structure. If endeavours aren’t fully supported by those in positions of authority the front line are extremely hesitant to adopt them (see here). Those in senior positions perhaps need to make the greatest change from being authority fihpgures to facilitators of ideas for improvement coined on the front line.

#TheatreCapChallenge – What’s all the fuss about?

#KnowYourHuman – when we accept that we’re all human and that we all mistakes we can design our work environments to cater for this (see here)

As mad as hatter? – system safety solutions have the potential to save hundreds of thousands of lives in healthcare however trying to implement them in healthcare frameworks resistant to change can send one mad. Something has to give (see here)

Human in the Team – choose to be human and part of a team and imagine the lives you’ll save (see here)

Fixing Healthcare Safety – if safety is to improve we’ll need to understand human limitation and work together to deliver effective safety interventions (see here)

Thank You Alison Brindle – when we have a culture which truly listens to and works with front line staff to deliver their brilliant ideas then patient safety will improve. Student Midwife Alison Brindle may have found a way to deliver this culture. (see here)

Where did you get that hat?

An increasing number of manufacturers supply name & role theatre hats. (see here) Please click on the images for link:

Thank you to everyone who supports this initiative. Thank you to those who continue to provide independent data on the impact of displaying names & roles.

A particular thank you to Dr Rhys Thomas, Alison Brindle and #hellomynameis Kate Granger & Chris Pointon.

We are doctors, nurses, midwifes, ODPs and other healthcare staff – we are dedicated and work as thoroughly as we can yet like all humans we will make mistakes. We can’t change this human condition but for patient safety we can change the conditions humans work within.