Anne van Dalen

The influence of working in a Black Box monitored operating room on safety behaviour I 201 7 Strengths and limitations The strength of this study is that, to the authors’ knowledge, it is the first study to use the HSOPSC survey to assess the impact of participation in video-assisted team debriefings, on perceived patient safety. Also, the survey was sent to all staff working at the OR complex, instead of just the surgical department, as it may be considered important to include the entire team when implementing a safety improvement tool such as the ORBB. 1,37 This study has some limitations as well. Firstly, the response rate was lower than expected, as only general invites could be sent out respecting new privacy laws. Even though, the survey was sent out by ORmanagement, instead of the study coordinator, to increase the response rate. Yet, even with the new privacy regulations preventing sending out personal reminders, still almost 1 out 4 invited completed the questionnaire. Also, in comparison to other studies, the sample size and response rate in this study remains above the average lower limit. 38 Secondly, regardless of the single-centre design and the sample size, safety behaviour (e.g. reporting incidents and communication openness) is often covert and difficult to measure. Safety behavioural intention may be influenced by many factors such as job satisfaction, hospital support, and beliefs. Even though surveys remain an important method in measuring culture, caution should be exercised in reliance on survey methods alone to measure safety culture. 7 Moreover, it was not possible to evaluate the safety behaviour of the non-responders. It is generally known that physicians are more likely to not take the time to complete a survey, when the relevance of the survey subject is perceived to be low or no direct ‘benefits’ for the individual are perceived. 39 This may emphasize why it is even more important to discuss the subject. 35,36