Anne van Dalen

44 I Chapter 1 professionals would be bound to work in a continuously monitored environment, where all results are accessible to patients. This may be an argument for organizations to start exploring optimal use of MDRs, which may secure optimal conditions for both patient and providers, as soon as possible. In the authors’ opinion, the fear that a MDR bears an increased risk of medical negligence litigation, limited performance or loss of professional status is unjustified, as long as good professional standards of patient medical record keeping and reporting of adverse events are maintained. 31,39,40,70,75,90 To help dissipate any remaining fear, resistance or doubt, the principal investigator of the MDR project can instigate an official agreement on confidentiality signed and supported by the hospital directorate. The researchers and the institute are, in accordance with the official agreement, bound to refuse the disclosure of any output obtained by the MDR. 77 It is important to emphasize that, if a severe adverse event occurs, video recordings usually help rather than harm the healthcare professionals involved. The chain of (re)actions and decisions resulting in the unwanted event are better understood with the objective help of the MDR. MDR data may help in augmenting the analysis of a calamity or near miss when constructing a public calamity report. The data source itself is protected by law. Besides, if he or she has provided reasonable quality standard of care, no punitive measures can be imposed. 91–93 Nevertheless, several hospitals in the USA ceased video recording after receiving legal advice to do so, as a result of their medicolegal concerns and the introduction of the HIPAA in 1996. 3 Hospital administrators, especially in the USA, are often extra cautious, owing to an increasingly hostile medicolegal environment. 12 Plenty of court cases have demonstrated that video recordings actually lend legal support to the healthcare professional or surgeon. 70–76 Healthcare professionals who are not well informed may also respond reluctantly to the use of a MDR, because they are afraid they will have to behave differently: ‘Can I still play music, make jokes or use bad language?’. It is important to take this viewpoint into account as well. Differences in staff perceptions of good behaviour may exist among team members working in a high-risk environment for behaviour that unsettles the team. 94–99 Disturbing behaviour or even bullying in the operating theatre, such as inappropriate joking