Anne van Dalen

4 Analyzing and discussing human factors affecting surgical patient safety I 133 Team members also indicated that participating in the debriefings made them feel “more valuable” and “part of the team”. This may have a positive impact on the personal well-being of the team members, job satisfaction, and organizational commitment. 51-53 Promoting these human factors is key when it comes to improving team performance and hence safety culture. 51-54 The evidence on the impact of the team’s skills on patient outcomes is still limited, as it is difficult to analyze these factors with traditional research methods. 26 55- 57 Objective multisource data is needed. 26 55 Video recording surgical procedures using an MDR is therefore believed to have multiple benefits. 58-60 The complex interactions between the clinicians and their environment can be captured at a level of detail that exceeds the capability of human observers, and surpasses their level of objectivity. 61-63 Ongoing research is recommended to improve the AI algorithms for this purpose. 19 Consequently, other healthcare professionals are also taking advantage of the use of video recording in- and outside the OR. 60 62 64 65 These innovative systems are likely to significantly enhance our understanding of the complex web of factors at play and their effects on patient outcomes and safety. 26 52 Future studies are needed to evaluate the feasibility, deployment and generalizability of such AI-based systems across different operating environment settings. 20 21 By evaluating qualitative observational data through debriefing and discussion, rather than by independently rating performance using the Likert-type scales of typical existing global rating tools, a more nuanced understanding of events may be gained. 66 Simply describing ‘errors’ committed in surgery and reporting their frequency does not appropriately capture the complex, independent factors surrounding intra-operative events. 48 53 Explicit clarification is necessary. To this end, team debriefing may be applied as an approach to improve patient safety. 26 42 67 This study has some limitations. It is important to stress that implementation of such a novel system, which impact on workflow is not yet understood nor investigated before requires a strict implementation plan; usually starting with qualitative research. For that, this was a pilot study with limited sample size. It was not possible to identify a trend or reduction in safety threats. Nevertheless, capturing and discussing these safety