Anne van Dalen

Summary and General Discussion I 253 and secure. 10 The team has to be satisfied with a system that ‘watches’ and ‘ judges’ them, to learn from unnoticed or differently perceived errors that may have taken place. Moreover, to implement this system sustainably, mutual confidence in its efficacy is key and therefore needs to be assessed. The mean score on the question: “How important do you feel it is to be able to structurally debrief surgical procedures with the entire team” was 8.44 (SD 1.2, 10-point Likert scale). Altogether, satisfaction of the surgical team with the use of the ORBB and corresponding outcome report for postoperative structured team debriefing was very high. The participating team members have considered the team debriefings to be important, useful, and educational. As participation was voluntary, it was expected that the participants would be satisfied with the outcomes of the project. This may have introduced a positive selection bias in our study. Yet, at the start of the project, only a few anaesthesiologists and nurses felt comfortable enough to participate. However, over time, the number of participants kept on growing steadily. The second group of adopters overcame their initial scepticism and reverted their opinion due to positive user experience shared by their peers. They came to better understand how their privacy was protected and experienced the benefits by themselves. Eventually, in 148 out of 151 times (98.0%) the participants recommended participating in the ORBB team debriefings to their colleagues. Future studies are needed to determine the effect of including the recording of the entire procedure (start when patient enters the OR and stop when patient leaves the OR) and subsequent anaesthesiology data analysis feedback embedded in the outcome report on satisfaction of the team concerning the ORBB system. The intra-operative events recognized by the ORBB and discussed during the team debriefings were assessed in Chapter 4 . Each of the 6 SEIPS categories; person, tasks, tools and technologies, organization, internal (physical) environment, and external environment were included. Both most identified resilience support events and safety threats were mostly related to the SEIPS category person. Most resilience support events were regarded as events subcategorized as effective communication (n = 77). Most safety threats were regarded as events subcategorized as unsafe acts (n = 236).