Anne van Dalen

3 Implementing structured team debriefing using a Black Box in the operating room I 103 especially when highly educated, are fluent in speaking and understanding English. 58,59 Although it was agreed that during the procedure the teammembers could always revert back to Dutch if considered necessary, having to speak English was mentioned to be a limitation to the natural workflow in the evaluation of the study, especially by the OR nurses. Another limitation of the study is that its results may have been influenced by the Hawthorne effect, a well-described phenomenon of an unintentional change of behaviour or productivity in response to the presence of an ‘observer’. 60, 61 It is known that this effect typically fades with time, as the team members are getting used to the observation, especially if the presence of an observer is not directly visible. 62 Our video recordings were made with surveillance cameras that were already mounted into the ceiling in most of our operating rooms. This non-obstructive set-up for observation is likely not to attribute much to a possible Hawthorne effect, as one is likely to forget a camera that is not disturbing one’s activities when focusing at tasks. The patient itself was not themain subject of this study. Therefore, no correlations could be made with the operative patient outcomes or clinical endpoints. Future studies may prove the direct or indirect benefits for the patients. Scheduling the multidisciplinary debriefings for such an amount of consecutive surgical cases with so many different team members proved to be a challenge during this study. Authors would have preferred scheduling the debriefings sooner to the surgery, but this proved not feasible in all cases. Nevertheless, having the objective information including the video footage in the outcome report sparked the memory satisfactory, according to participants. Results of this study show that neither the number of team members attending the team debriefing, nor number of workdays between the procedure and debriefing was significantly associated with the satisfaction scores. As a recommendation, authors believe that inviting OR personnel to participate in about 2 multidisciplinary debriefings per year may already be a great facilitator in better understanding each other’s need. Whether or not it is widely generalizable to have an independent person, such as a professor of psychiatry, moderate the sessions and the cost-effectiveness remains open to discussion.