Anne van Dalen

166 I Chapter 5 IQR 0.0, F-test P-value <0.0001). These are both important aspect of the team’s crew resource management skills. Why did the surgical fellows rate their own well-being significantly lower than their resident counterparts? This may be in part caused by stress surrounding career choices and stability. Other factors known to influence staff well-being include workload, climate, or perceptions of teamwork. These human factor elements have been found to have significant associations with burnout symptoms, job satisfaction and organizational commitment. Burnout symptoms, such as emotional exhaustion, fatigue and an inability to concentrate, may hinder one’s capacity to ensure surgical safety. 7 Teamwork and well- being have been linked in a similar manner to mental stress and surgical performance. 8 Hence, promoting staff well-being may serve to improve crew resource management skills, organizational outcomes and consequently surgical safety. Concerning the environmental factors, the staff surgeons more often identified distractions (51.3%, n = 61) and aberrations (60.5%, n = 72) during surgery, compared to all the other team members. These were usually related to technological issues, such as inadequate anastomosis closure (n = 20), bleeding (n = 16), small bowel injury (n = 10), malfunction equipment (n = 9), or poor trocar placement (n = 6). Although distractions or aberrations during surgery are inevitable and almost ‘come with the job’, they can be detrimental to overall team performance. Each team member may have a different sense of what is a distraction or aberration, and thus act differently in identifying threats to surgical safety. Indeed, individuals vary in feeling the urge or responsibility to alert the team on a perceived distraction or aberration. They may act differently taking responsibility attempting to resolve the possible safety threat. Yet, the delivery of safe, high-quality care depends on the sound judgement and decision- making capacity of all members of the operating team. Highly cohesive teams with strongly connected members may support the expression of individual opinions, which may promote identification of an active or latent unsafe acts. 9 If unsafe acts are identified pro-actively, this may mitigate peri-operative errors, as these are usually the result of a cumulation of minor active or latent aberrations resulting from different factors in the OR. 5