Becker's ASC Review

69 HEALTHCARE NEWS 69 "One area that is very chaotic is our trauma bays," Dr. Mantyh said. "I remember as a resident way back when the trauma bay was the most chaotic area in the hospital. Obviously, time is of the essence. Patients can have a lot of things going on. But if you actually do it well, it is an amazingly efficient and potentially lifesaving area. So we're thinking about putting [a black box] in there." Duke is also prioritizing its robotic rooms and looking to expand into other areas, including thoracic surgery, gynecology and urology, he said, adding, "I think people are clamoring to see how we can do it better. I do think [the black boxes] are here to stay." Dr. Cleary agreed: "is is a disruptive technology, and I use disruptive in a good sense." e positive and the punitive Both Duke and Mayo Clinic have had to overcome concerns from staff members who worried the technology would be used to punish clinicians. However, Dr. Cleary and Dr. Mantyh said the technology has allowed for more positive reinforcement than punitive action. In part, this is due to the data being disidentified and anonymized. Aer 30 days, the footage is deleted to protect the privacy and confidentiality of patients and healthcare providers, Surgical Safety Technologies founder Teodor Grantcharov, MD, PhD, told e Wall Street Journal. "It's not about Jane or Joe's individual performance," Dr. Cleary said. "e whole spirit behind this system is to make things in the operating room work better. It's made to make things safer." Morbidity and mortality reviews are one area that has seen improvements in punitive versus positive reinforcement. "Traditionally, it was a bunch of surgeons and nurses in a room together retrospectively recollecting what happened, and to say it was subjective would be very kind," Dr. Cleary said. "What this has done is allowed us to bring some objective data into that discussion. We can say, 'When we did this it wasn't really effective, but when you did this, this is what happened.' e natural tendency of a M and M, in a historical sense, has been to focus on when things go wrong. But this system actually allows us to focus not just on critical events that didn't go according to plan, but to look at when things went right with exemplary function, performance or teamwork and use that as an example for how we should function all the time." However, there are still concerns about the video potentially being used in legal action against healthcare workers. "People always want to know about privacy," Dr. Mantyh said. "Everything from HIPAA stuff on the patient side to what will be discoverable from the surgeon side and the healthcare provider side." So far there have been no cases in which black box video has been used in legal action. And, Dr. Cleary noted, "e fear of that kind of stuff can't stop us from getting better. at's allowing the legal system to paralyze the medical system and to enact it to virtual inactivity. [If that happens], we've made things worse." n Fight unfolds over measure to cap pay of LA hospital executives By Molly Gamble A Los Angeles ballot measure backed by SEIU- United Healthcare Workers West would cap pay for hospital executives at the compensation of the U.S. president, or $450,000 per year. The California Hospital Association is challenging the measure, arguing that the president earns more. The proposed limitation would apply to any executive, manager or administrator at privately owned hospitals in Los Angeles, as well as skilled nursing facilities, residential care facilities and all facilities within integrated health systems. The $450,000 cap is inclusive of all compensation, including salary, paid time off, bonuses, incentive payments and lump-sum cash payments. Federal code states that the president is paid $400,000 annually with an expense allowance of $50,000. "The compensation paid to chief executive officers, executives, managers, and administrators of hospitals and other healthcare facilities is often excessive, unnecessary, and inconsistent with the mission of providing high-quality, affordable medical care for all," the measure states, arguing that $450,000 per year in compensation will leave city hospitals "more than able to attract and retain effective executive leadership." The California Hospital Association has filed suit challenging the measure, arguing that the U.S. president earns more than $450,000 per year when travel expenses, discretionary funds and residence in the White House are factored in, according to the Los Angeles Times. The hospital association cited calculations by a consultant who concluded that the total compensation tops $1.2 million. The alleged numerical mismatch means the ballot measure petition contained "calculated untruths" that misled voters who were asked to sign it, the CHA argues. It is calling for the courts to block the initiative from appearing on the ballot. A court hearing is scheduled for April 4. Supporters of the ballot measure have called the CHA's counter-calculation a "tortured explanation" in a court filing, according to the Los Angeles Times. This isn't the first time SEIU-United Healthcare Workers West has moved to cap Los Angeles hospital executives' pay. The union has proposed and abandoned a similar measure but at the state level in the past, and in 2019, it proposed the same ballot measure for the November 2020 election. n

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