Anne van Dalen

The influence of working in a Black Box monitored operating room on safety behaviour I 187 7 INTRODUCTION Studies have demonstrated that human factor failures are most often the root-cause of surgical adverse events, rather than technical skills. 1, 2 Consequently, video- and medical data recording in theOR is increasingly used as an intervention to improve surgical quality and safety. 3, 4 Such a medical data recorder, the OR Black Box (ORBB), is implemented at our tertiary referral centre. 5 It was assumed that use of the ORBB output as discussion template for structured team debriefings may help foster a shared mental model on peri- operative situations. 3,4 Implementation of such a quality improvement intervention is however challenging. It is bound by existing cultures, beliefs, ethics, medicolegal- and privacy issues, logistics, time and finances. 6 In the OR, professionals from various specialties, disciplines and level of seniority work closely together in a high-stress environment. Their safety behaviour (e.g. reporting incidents, speak up when an error occurs) may be improved by use of the ORBB. Important factors influencing the intention to engage in safety behaviour are; behavioural beliefs (whether the individual believes that the behaviour will improve safety), behavioural outcomes (whether the individual has experienced improved safety resulting from the behaviour), and an individual’s perception about their colleagues’ safety behaviour. 7 In order to sustainably implement a safety improvement initiative such as the ORBB, it is hence important to understand the attitudes, beliefs and perceptions concerning safety culture of all professionals working in the OR. 8 The aim of this study was 1) to assess OR staff’s attitudes towards patient safety culture in the OR specifically, and 2) to evaluate if working with an ORBB influences their perception of patient safety.