Anne van Dalen

164 I Chapter 5 Human factor failures have been identified as major underlying causes for surgical adverse events. However, the impact of such adverse events might not always be evident nor apparent. 1 The operating room (OR) is a unique and high-stress environment. Professionals from various specialties, disciplines and level of seniority are required to work closely together as a team. For effective teamwork, it is hence important to ensure that a shared mental model is perceived by all members of the team. This requires the creation of a supportive and safe environment in which the entire team is able to speak up, and team members know what is expected. 2 A high level of individual ‘human factor skills’ is required as well. Prior research has demonstrated that OR staff may have discrepant attitudes about the level of human factor skills exhibited from one another, which may be caused by differences in status or authority, responsibilities, and culture. 3 The Human Factors Analysis and Classification System (HFACS) was developed in response to a trend showing that human error was a primary causal factor in 80% of all flight accidents in the Navy and Marine Corps. 4 HFACS is based on the “Swiss Cheese” model of human error which looks at Reason’s four levels of human failure, including organizational influences, unsafe supervision, preconditions for unsafe acts, and unsafe acts. 5 The HFACS model, as shown in Figure 1, may offer tools for human factor analysis to plan solutions to prevent human factor failures. 4 In order to get more insights in relevant human factors in the OR, we carried out an international multi-center survey study in St. Michael’s Hospital (Toronto, Canada) and the Amsterdam UMC, location AMC (The Netherlands). In both locations, a medical data recorder, the OR Black Box® (ORBB) is in use. Between September 2016 and July 2018, 117 elective laparoscopic procedures were recorded using ORBB. The Surgical Team Assessment Record (STAR) questionnaire was administered in both centers. This questionnaire investigates the HFACS’s organizational, environmental and personal factors. 6 The questionnaire, previously used and validated across different surgical settings, was adjusted to better reflect and fit these HFACS factors possibly leading to unsafe acts in laparoscopic surgery.