In a move that seems to many to be going over the edge of what is reasonable, a Maryland court recently approved federal stimulus funds to be used for “secret shoppers” that monitor the hand washing habits, among other things, of health professionals in various medical organizations across the state. Forty-five out of Maryland’s forty-seven acute care hospitals have joined the initiative.

While such moves do a lot to inspire the confidence of possible patients, they may do more to erode the morale of medical workers. This is the first time that such an initiative has been established with federal funding in the US.

Patient safety professionals have implemented a host of various surveillance tactics to keep tabs on doctors, such as motion sensors and RFID chips. However, even patient safety advocates acknowledge that such measures have to be put in place sensitively and used in a non-punitive manner in order to avoid a complete revolt on the part of those who are being monitored.

On the flip side, there is data that shows that such monitoring works. The company Arrowsight is one of the many suppliers of monitoring equipment, including video cameras that are monitored on handwashing stations. An Arrowsight 2007 test project conducted at an ambulatory surgery center with around 20 workers saw a huge jump in hand hygiene use from 35% to more than 90% within two months of having the equipment installed.

Arrowsight argues that their monitoring also allows participating organizations to reward consistently high standards among its staff that may have gone unrewarded before. 

While the Maryland initiative is voluntary, sometimes surveillance is not voluntary. Rhode Island State Hospital received a court order to install cameras in operating rooms after several malpractice suits were brought against the organization within a short time period. It can be argued that proactive installation of such equipment is in the best interest of the organizations involved given that they can then provide up to the second video of procedures in which malpractice is alleged.

Whatever our personal opinions are on the subject, it looks like insurance companies and courtrooms may make some surveillance equipment mandatory in the years to come. The trick is to find a balance that physicians can live with while satisfying the requirements of patient safety experts, insurance companies, and the courts.