Anne van Dalen

Six Sigma in surgery I 241 9 such as longterm learning, improving team performance, and innovation, known as error management. Transparency regarding errors in healthcare is needed, but has proved difficult to achieve. 3,13 Healthcare is complex because of the diversity of professionals, each with their own educational background, attitudes, and standard procedures. 14 Regardless, a shared mental model is essential in high-risk environments such as the operating theatre. A shared mental model indicates that all members of the operating theatre team have a common understanding of the plan for patient management, and of the roles and responsibilities of each individual, ensuring a psychologically supportive and safe environment. 15 One in which every team member feels respected, encouraged, and safe to speak up. 3,4 This appears to be difficult to accomplish, even when teams work together regularly, and therefore requires leadership, communication, commitment, resources, and awareness from both the entire operating theatre team and the organisation. 1,2,15 How can we use the Six Sigma approach? Measurement and understanding the team’s current performance, where the team can improve, and the ability to learn, are essential components of ensuring safe patient care. 16 Six Sigma performance might be achieved by creating a continu- ously monitored operating theatre, capturing natural behaviour and standard operative processes, in order to define both the technical (i.e. technology, managerial, or engineering) and non- technical (i.e. human) factors possibly affecting safety. Comprehensive data capture systems such as an Operating Room Black Box are therefore becoming more widely implemented in high-risk environments such as the operating theatre, trauma bays, and in simulation training centres to measure, analyse, and train teams. 17 These devices collect complex real-time quality data obtained from views of the surgical field, nursing station, laparoscopic camera, and anaesthesia monitoring devices using privacy-by-design principles. 10 Visual data analytics based on big data may facilitate perioperative outcomes research, quality improve- ment efforts, and real-time clinical decision-making. 16,18 Video recordings of the entire operating theatre allow an unbiased and de-identified evaluation of patient anatomy, the operating theatre team, and perioperative activities. 7,17