Anne van Dalen

16 I General Introduction Human errors in the operating roommay influence the occurrence of errors that include medication errors, procedural errors and errors in execution. 30 In the aviation industry, the role of human factors (situational awareness, decision making, communication, teamwork and leadership) in flight safety has been identified in the 1970s through analysis of data from cockpit voice recorders and flight data recorders after severe accidents. Analyses showed that human factors were the root cause in over 70% of accidents. 31 Human factors have become increasingly recognized as root causes in adverse outcome and patient injury or death related to surgical procedures. Fabri et al. 32 also demonstrated that human error is the leading cause of surgical error. In a recent report of sentinel event data between 2004 and 2014, the Joint Commission analysed 845 major peri- and postoperative complications and confirmed that human factors (63%), communication (53%) and leadership (41%) failures were the root cause of major loss of function or even death. 12 Communication Communication is “the exchange of information between a sender and a receiver.” In the operating room, multiple individuals communicate simultaneously, hence it is one of the most studiedandmost critical humanfactors inmedicine. 33 IntheSafeSurgeryGuidelines, the WHO has emphasised the need for effective, open and clear communication to improve the safe conduct of surgical procedures. 6 Regardless, miscommunication during surgical procedures still occurs frequently and has been implicated as one of the major causes of error and adverse outcomes in general surgery. 17,34 Moreover, communication skill has been measured as one of the worst aspects of team behaviour in the operating room. 17 Yet, miscommunication has multiple etiologies and therefore improvement initiatives need a multipronged approach. 33 The aviation’s well described cockpit resource management principles state that good communication principles are as follows; all team members should address one another directly by their name and the closed-loop communication technique should be used. Closed-loop communications means that the receiver repeats the message to ensure avoidance of miscommunication. 35