Dr ROB Hackett was met with smirks and confused, occasionally derisive, looks when he started turning up to surgeries with his name and profession emblazoned in bold black typeface across his scrub cap.
"Rob ... Anaesthetist", his forehead announced to colleagues and patients alike.
"You look a little daft because not everyone is doing it," Dr Hackett said.
"There were some side remarks, like 'can't you remember your name'."
But six months on, Dr Hackett's bid to improve patient safety is gradually gaining support from surgical staff in Australia and internationally.
The move, they argue, could reduce the chances of delays and misidentification when clinicians can't recognise or can't remember the names of their colleagues in the operating theatre.
Surgeons, anaesthetists, nurses, midwives and other clinical specialists are sharing photos of themselves donning the cranial name tags, their identities, printed neatly on cotton hats or scrawled with black permanent marker on paper caps.
Alison Brindle, a UK student midwife, gifted Dr Hackett's intervention with the hashtag #TheatreCapChallenge. Surgical staff from Australia, the UK, US, Europe and South America have used the hashtag to share images of their own name-caps.
There's Beth, Nurse and Caroline, Opthalmologist. There's Alison, Student Midwife and Jo, Obstetrician.
When hospital staff are in full scrubs, their faces are almost completely obscured by their caps and face masks, with their eyes and eyebrows suspended between the two.
Clinicians can work with hundreds of different combinations of colleagues between multiple hospitals. The revolving door of partial faces can make recognising your fellow staff member instantly, in time-critical moments, challenging.
In the midst of a medical emergency, precious seconds, even minutes can be lost when clinicians can't remember the names of their colleagues in the operating theatre, the campaign's supporters say.
In a critical iteration of the bystander effect, Dr Hackett said there have been delays in performing chest compressions on patients in cardiac arrest because no one in the operating room at the time knew who the clinician had tasked with the job, since they had not referred to anyone by their name.
Other theatre staff told Dr Hackett of incidents where medical students had been mistaken for surgery registrars and asked to complete procedures.
"When you work across four or five hospitals and with hundreds of people, I'd say 75 per cent of staff I walk past I don't know their name. It's quite awkward," Dr Hackett said.
"Last Friday I went to a cardiac arrest in a theatre where there were about 20 people in the room. I struggled to even ask to be passed some gloves because the person I was pointing to thought I was pointing to the person behind them."
"It's so much easier to coordinate when you know everyone's names. It's great for camaraderie and it's great for patients as well."
Dr Hackett said women having caesarean sections in particular might benefit from the reassurance of knowing the names and positions of every staff member in the theatre simply by looking at their caps
Operating theatres abide by the World Health Organisation's surgical safety checklist, which requires all staff to introduce themselves prior to surgery. Dr Hackett said in his experience, this component of the checklist was often disregarded as a tick-box exercise.
"When it's done properly there are a few giggles from people, which tells me it's not done regularly," he said.
D Hackett said the campaign had been met with resistance from some, usually senior, hospital staff, which he believed was symptomatic of inertia in the health system towards change.
"This is a really simple intervention," said the anesthetist, who is trying to work with hospitals to run trials to determine the effect of the name-caps.
The campaign is reminiscent of the #hellomynameis campaign founded by Dr Kate Granger, who died of cancer 2016.
During a hospital stay for post-operative sepsis in 2013, Dr Granger observed that many staff charged with her care did not introduce themselves, missing a valuable opportunity to strengthen therapeutic relationships and build trust between staff and patient.
Dr John Quinn, Executive Director Surgical Affairs at the Royal Australian College of Surgeons said the #TheatreCapChallenge campaign was "a fine idea".
"Anything that increases safety for patients in operating theatres is a good thing," Dr Quinn said.
Though he did not think the intervention would drastically change best practice, arguing the surgical safety checklist, that involved staff introducing themselves at the beginning of each day effective and dispelled the embarrassment staff felt when they did not know their colleagues' names.
"I don't see a downside to it," Dr Quinn said.
"I guess it's just a matter of whether they use their full name or first name, though just 'Tim' is better than anything in a crisis.
Chair of the Australian and New Zealand College of Anaesthetists Chair of the Safety and Quality Committee Professor David Scott said any move that would improve coordination among operating room teams was worth doing among other strategies including clear and bold name badges on scrubs.
"No one strategy is going to make a dramatic difference but knowing who's who in a busy operating room means teams will be able to communicate more effectively," he said.
