Anne van Dalen

4 Analyzing and discussing human factors affecting surgical patient safety I 121 It was ensured that faces of staff and patients were blurred, and voices altered. Given the sensitivity of outcome, the report was double-checked for bias, error and false positivity by qualified human experts in a multidisciplinary analysis team before it was finalized. The performance report included video segments of all relevant identified safety threat and resilience support events. These events were coded using the automated Systems Engineering Initiative for Patient Safety (SEIPS) model. Our research group modified the SEIPS model to analyze the system factors that impact patient safety in minimally invasive surgery specifically. 12 This validated model helps to understand the healthcare system through the interactions of six categories: person, tasks, tools and technology, psychical and external environment, and organization. 14 15 7 The video segments selected by SEIPS included qualitative descriptions of the event. The finalized MDR outcome report was securely returned to the project coordinator to be used for the debriefing session. 28 These debriefings were planned at least 48 hours (i.e. “cold debriefing” 36 ) and thereafter, as soon as possible after the surgical case, to make it possible to conduct this in a neutral environment (outside theOR). 28 37 All teammembers were invited to participate by e-mail. The study coordinator scheduled the debriefing session on a moment during the week that suited as most team members as possible, taking into account the busy and irregular work shift schedules. An independent facilitator (professor of psychiatry) led the video-assisted debriefing using the standardized debrief model 37 to safeguard the debriefing process in a structured manner, securing safe, non-hierarchical and optimal debriefing for all team members. 37 The debriefing started by discussing what aspects of the case went well according to the opinion of the team members, by focusing on debriefing a resilience support event first. Hereafter, at least two other relevant events were chosen by alternating team members to discuss; either labelled as resilience or safety threat. 37