Anne van Dalen

254 I Summary and General Discussion The multidisciplinary debriefing sessions following the recorded cases most often discussed events related to communication and situational awareness. Effective teamwork is a strong predictor of effective communication and our results may once again highlight the importance of clear communication in the OR. Participants in this study indicated that debriefing provided them with the opportunity to “speak up” more easily. Cultural, professional, and organizational factors predispose people to avoid speaking up, and is often the final barrier to an adverse event in the making. 11-13 Speaking up to raise concerns about a perceived safety threat or behaviour may therefore have a direct and preventive effect on adverse outcomes. 12 14 Besides, it has been acknowledged that simply describing adverse events in surgery and reporting their frequency does not suffice when it comes to preventing them from happening again in the future. Explicit clarification and a shared perception of the situation is needed. Therefore, research that adds to the growing body of knowledge concerning relevant safety threats and resilience support mechanisms in the OR is valuable for future surgical quality improvement initiatives. The results of our study may make surgical teams realize the important effect that miscommunication and incorrect assumptions may have on team performance and surgical safety. The postoperative debriefings may be considered an especially valuable intervention toclarify safety threats causedby ineffectivecommunication. Teammembers also indicated that participating in the debriefings made them feel “more valuable” and “part of the team”. This may have a positive impact on the personal well-being of the team members, job satisfaction, and organizational commitment. 15-17 Promoting these human factors is key when it comes to improving safety culture. 15-18 To this end, team debriefing with the use of the ORBB outcome report may be applied as an approach to improve safety behaviour of the surgical team. We therefore may recommend to invite staff working in the OR to participate in about 1 to 3 team debriefings per year to continue evaluating and improving their safety behaviour and the safety culture in the OR. The patient itself was not the main subject of this study. Therefore, future larger studies are needed to evaluate the direct or indirect positive impact of the use of the ORBB used for team debriefing on postoperative patient outcomes.