Anne van Dalen

Summary and General Discussion I 251 improvement purposes, such as team debriefing. If a severe adverse event occurs during the recorded procedure, video recordings usually help rather than harm the healthcare professionals involved. If he or she has provided reasonable quality standard of care, no punitive measures can be imposed. In conclusion, the fear that use of the MDR bears an increased risk of medical negligence litigation, limited performance or loss of professional status is unjustified, as long as good professional standards of patient medical record keeping and reporting of adverse events are maintained. Yet, clear legislation on the use of MDRs in the OR for quality improvement purposes is needed. In Chapter 2 we combined relevant findings from a literature review, experience with team debriefing in simulation settings, and implementation of the ORBB and its outcome report to develop a novel debrief model to be used for video-assisted team debriefing. A standardized debrief model is needed to debrief the surgical team in an efficient and effective manner, taking into account the busy working schedules of all the healthcare professional involved. Structured debriefing minimizes resource, effort, and motivational constraints. 1 2 Powerful status- and role-based hierarchies often characterize healthcare teams. It is important to realize that hierarchy and status may affect group dynamics negatively during the debriefing session. 3 Creating the correct conditions is hence key to a successful team debriefing. 4 Therefore we recommend to organize the debriefing in a neutral environment, outside the OR, and let the team members sit at a round table. When reflecting upon actions, participants should share the feeling of being safe and respected in their individual roles and privacy. This may help participants to open up and speak their mind freely. An independent moderator to lead team debriefing may be essential, safeguarding aforementioned conditions. It may be recommended to focus on the non-technical human factor aspects, such as communication and teamwork rather than individual technical skills to improve surgical outcomes. 5 6 Video-assisted debriefing is believed to be more objective, effective and educational. 7 8 The outcome report used in the debriefing can be automatically analysed with the use of artificial intelligence and machine learning software, based on validated human factors related rating scales. The independent facilitator of the