Doctors’ health and wellbeing: Self matters

Self matters Name-role hats: improving trainee experiences

The challenge of change In this edition’s article, Dr Munro Brett-Robertson reflects on his passion for change, arising from his early experiences as an introductory trainee. Taking up the #theatrecapchallenge to wear namerole hats, his report reminds us that trainees moving between hospitals must adjust repeatedly to new staff and routines. No doubt this problem is also experienced by medical students, and trainees and students in other health disciplines. For all of us, our teams frequently reconfigure. Misidentification in the workplace occurs more often for women. Dr Brett-Robertson’s female colleagues report this improves when they wear the name-role hats. The outcome of not knowing those around us, particularly in emergent situations, is potentially catastrophic for our patients. It has wellbeing implications for all staff, and is felt particularly by those new in our teams. I thank Dr Mary-Ann Fox for introducing me to Munro. As always, I welcome ideas for future columns and authors at lroberts@anzca.edu.au.

Dr Lindy Roberts AM ANZCA Director of Professional Affairs, Education

DO YOU FEEL like nothing ever changes at work? As if the cogs of the healthcare machine are so big there is nothing any one person could do to change anything? I want to tell you a story about how, as a trainee, I felt empowered (with the right support and some luck) to make a difference.

Starting out as a new anaesthesia trainee in theatres can be daunting – a new specialty, new hospital perhaps, almost certainly new staff to get to know. When I started training in 2018, I at least had the benefit of having worked at that hospital for two years in the emergency department (ED). Similar to the giddy feeling of buying your first stethoscope when getting into medical school, I wanted to buy myself a scrub hat for my new job. After all, with everyone in theatres wearing scrubs, hats are one of the few ways we can express ourselves through our attire.

WHY?

The aim of the 2018 Twitter campaign #theatrecapchallenge was to encourage all theatre staff to wear scrub hats printed with their name and role1. This improves patient safety by enhanced closed loop communication and identifies team skill sets, especially during resuscitations. At Starship Hospital in Auckland these hats improved identification and communication for both staff and patients2. By encouraging reusable hats, hospitals also reduce costs and waste. There is no evidence that infection control is worse with freshly laundered cotton hats. This resonated with me – I had no idea who anybody in theatre was and communication would have been so much easier if identification hats were the norm. Alas, no such luck, but at least I could be the change I wanted to see – I ordered a black cap with my name and role embroidered in silver. Not quite as expressive as my colleagues would expect of me now, but a start. Learning new names never seems to end as a trainee, as we often move hospitals every year or so. At least mine would be one less name for my co-workers to remember. “Just imagine if we all had them!” I thought. During my training I bought increasingly more colourful hats, but it never seemed to catch on. I didn’t see another name-role hat until my final training rotation, three years later at the Royal Adelaide Hospital (RAH). There, anaesthetists Dr Mary-Ann Fox and Dr Cameron Main wore them too. Seeing this encouraged me to do a departmental presentation on the benefits, aiming for momentum in staff uptake. While I received encouraging words from some attendees, no more hats materialised.

HOW?

It was clear passive exposure would not work. This needed some active intervention. Dr Fox and I contacted the RAH chief executive officer (CEO), Professor Lesley Dwyer, through Twitter, requesting financial support. We didn’t have to do much convincing as she had already heard of #theatrecapchallenge and its benefits while working in Medway, England. As a trainee, it was intimidating meeting our CEO, but she was enthusiastic, approachable and in a position to provide financial backing. The head of perioperative nursing requested I present to all the theatre nurse unit managers. Their concerns were colour choices, laundering and infection control. I was prepared for these questions, and they gave their blessing. Having CEO support before engaging with the nursing leadership made a big difference in convincing them. I didn’t want to ask for too much at once, so we started with the anaesthetists, anaesthetic nurses and recovery nurses. The supplier arranged a slick web order system that staff could fill themselves via a QR code or email link. Subsequently, the hospital funded one hat for every staff member who wore one at work. This included the orderlies, radiographers, perfusionists, surgeons and other proceduralists. Even the ED got involved. This was motivated by the Autumn 2022 COVID peak, with the hats seen as improving communication while wearing personal protective equipment (PPE).

Like Aesop’s fable The North Wind and the Sun, encouragement is often better than decree for engagement. These hats weren’t compulsory, staff could choose their colour and didn’t need to use them every day. All were reminded of the importance of regular laundering. Our aim was to generate a critical mass of staff wearing them so that once their benefit was experienced first hand that others would source their own hats for daily wear.

SO, WHAT HAPPENED?

After confirmation that the administration endorsed and funded them, staff were extremely enthusiastic. The hospital purchased 780 hats. Our supplier even made one for a visit by South Australian Minister for Health and Wellbeing, Mr Chris Picton (right), presented to him by Professor Dwyer. The ED is so pleased with the results that they plan to purchase additional hats every time they have new employees. Following a network-wide email update in which the project was highlighted, I was approached by department leads from another hospital asking if I could

FIGURE 1: SURVEY OF RAH ANAESTHETIC STAFF BEFORE NAME-ROLE HAT ROLL-OUT

# Responses from 77 of 137 contacted

Evidence supporting name-role hats The PatientSafe Network (www.psnetwork.org/ theatrecapchallenge-wheres-the-evidence/) webpage #TheatreCapChallenge: Where’s the evidence? includes a list of publications and other resources addressing issues, name-role hat benefits and concerns (including about infection-control).

co-ordinate a theatre-wide hat order on their behalf. After a recent anaesthetic Facebook group post, multiple anaesthetists around Australia contacted me seeking help with convincing their own theatre management. From a wellbeing point-of-view, the benefits include enhanced collegiality, improved staff satisfaction and better communication2. Forging new relationships with your colleagues is easier, offsetting the effects of changing hospitals every year. Additionally, the hats promote accurate role identification. Misidentification is more commonly experienced by women and is associated with physician burnout. In the US, 77 per cent of trainees reported being misidentified weekly, often by patients and their families: being female vastly increased these odds3 . Burnout was more likely in those reporting misidentification. Identification hats improve role recognition4 . My pre-rollout survey found that three quarters of departmental members experienced role misidentification (see Figure 1). Following introduction of the hats, I have heard from anaesthesia colleagues, mostly women, that they are no longer misidentified. If there is something you had wanted to encourage at work but didn’t relish the potential struggle for implementation, I would say go for it. With the right support and a bit of luck it can be done.

And now ordering coffee at the hospital café with an unusual name like Munro is no longer difficult! Dr Munro Brett-Robertson Anaesthetic Provisional Fellow, SA Health

Acknowledgements: My thanks to Dr Mary-Ann Fox and Dr Lindy Roberts for their assistance with this article.

References: 1. Patient safety: #TheatreCapChallenge goes viral. ANZCA Bulletin

March 2018 pp28-29. 2. The impact of personalised theatre caps in Starship Hospital operating theatres. ANZCA Bulletin Spring 2020 pp30-31. 3. Jain N et al. Sex-based role misidentification and burnout of resident physicians. An observational study. Ann Surg 2020;276:404. 4. Rosen DA et al. Utilization of a role-based head covering system to decrease misidentification in the operating room. J Patient Safety 2019;15:e90.

Free ANZCA Doctors’ Support Program

How to make an appointment: To speak with a counsellor over the phone or make an appointment to see a consultant for a face-to-face session: • Telephone 1300 687 327 in Australia or 0800 666 367 in New Zealand. • Email eap@convergeintl.com.au. • Identify yourself as an ANZCA/FPM fellow, trainee or SIMG (or a family member). • Appointments are available from 8am to 6pm Monday-Friday (excluding public holidays). • 24/7 emergency telephone counselling is available.

HELP IS ALSO AVAILABLE VIA THE Doctors’ Health Advisory Services:

NSW and ACT 02 9437 6552 NT and SA 08 8366 0250 Queensland 07 3833 4352 Tasmania and Victoria 03 9280 8712 WA 08 9321 3098 New Zealand 0800 471 2654

Lifeline beyondblue 13 11 14 1300 224 636