Anne van Dalen

100 I Chapter 3 in comparison with the other team members, experience and therefore describe or remember certain events differently. The need for a more multidisciplinary approach to quality improvement initiatives may hence be recommended. 37, 45, 46 Moreover, it is known that communication and the performance of the team is usually graded higher by the surgeon. 47–49 This may further be explained by the fact that this project was an initiative led and strongly supported by the participating surgeons. As participants were asked to voluntarily participate in the TOPPER-trial, it was to be expected that they would be satisfied with the outcomes of project, introducing a positive selection bias in our study. Yet, at the start of the project, only a few anaesthesiologists and nurses felt comfortable enough to decide to participate and sign the informed consent. Interestingly, over time, their participation numbers kept on growing steadily in the study. An effect that can presumably be contributed to the ‘grapevine’, e.g. the positive responses of the already participating team members. Indeed, several healthcare professionals who were initially unsure or even quite sceptical towards the initiative decided to participate in the team debriefing during the trial based on positive experiences shared by their peers. When these second group of adopters overcame their initial scepticism, they reverted their opinion due to actual user experience. They came to better understand how their privacy was protected and experienced the benefits first-hand. As a result, initial laggards became the most important drivers and advocates for the initiative. In this study, only 3 participants indicated not to recommend participation to peers, of which 1 surgical resident and 2 anaesthesiologists. The surgical resident commented that the answer was ‘no’, because during that particular debriefing, the staff surgeon had to cancel his or her attendance to the team debriefing last minute. Without the staff surgeon, in combination with a relatively ‘uneventful case’, the surgical resident considered the team debriefing to be not so useful. Two anaesthesiologists answered ‘no’ on the question if they would recommend use of the system for team debriefing to peers. Anaesthesiology data were indeed captured in real time by OR Black Box® (e.g. blood pressure, heart rate, oxygenation, etcetera) and reflected in Black Box® output, but the assessment algorithms at that time were not well enough developed to provide the same granularity of assessment as for the surgeons and OR nurses. Also, to protect the privacy