Anne van Dalen

The influence of working in a Black Box monitored operating room on safety behaviour I 199 7 are urged from the first days of training to step up to the plate and own sole responsibility for their actions. 24 Yet, errors ought to be managed in a ‘ just culture’ instead, where all team members feel confident to report events (even their own mistakes), and by promoting collective accountability. 6,25 The concept of ‘collective accountability’ entails that all providers work collaboratively and share responsibility for transparency, error prevention, and error management. 26 Healthcare organization have therefore the responsibility to implement non-punitive reporting systems and to support clinicians when errors occur. 11,27 The results of this study may also suggest that, perhaps unexpectedly, the attitude of participants of the ORBB trial towards the overall patient safety was possibly less positive compared to those who did not participate. Besides that, working full-time seemed to have a positive impact on attitudes towards patient safety. It may be the case that professionals already having high standards in this domain, many of them working more than full-time, are the ones most critical. This may reflect in them expressing a lower overall perception on patient safety. Also, whilst working more, and also night-time hours, they may have been more involved in cases negatively impacting patient safety and therefore especially want to participate (i.e positive safety behaviour). Moreover, participants in theORBB trial may have been faced withmore aspects of safety behaviour during the team debriefings, compared to those who did not participate, and therefore have created -unconsciously- more awareness concerning patient safety improvement gaps. One way or another, early adopters or ‘believers’ already having a mind-set positive towards an innovation such as ORBB were of great value in organizations tilting towards a culture shift. Indeed, such mind-sets need to be cherished and nourished. Implications for policy, practice and research The goal of improving safety culture is aimed at encouraging all OR team members to be transparent about issues that may impact patient safety, as highlighted by the safety dimensions in the HSOPSC survey. 23 Healthcare professionals take care of patients as teams, err as teams, and need a way to accept accountability as teams. 27 Organizations need to consider the behaviour of the healthcare professionals as well as the complex