Anne van Dalen

Summary and General Discussion I 255 Part III: Improving surgical quality and patient safety in the operating room Delivering safe surgical care can be extremely complex. It requires a combination of technical skills, professional conduct and interpersonal communication. Multiple factors have been recognized to influence surgical safety. 19 20 These may include the surgical team, social interactions, technology, organizational and environmental factors, patient characteristics, and the complexity of the procedure itself. 21 Yet, human factors, such as teamwork and communication, have been identified as major elements affecting surgical safety. 19 22 Consequently, substantial data exist regarding the impact of improving human factor skills through the use of checklists, briefings and debriefings, coaching and simulation training. 20 23-25 However, the OR is an unique high-stress environment comprised of professionals from multiple specialities, who’s training may differ widely. Tailored safety improvement interventions, including the entire team, have thus been recommended. Yet, greater detail regarding the varying etiologies of safety improvement gaps is needed. 26-28 In Chapter 5 differences in perception among operating staff regarding human factors in the OR are evaluated. We carried out an international multi-centre survey study in St. Michael’s Hospital (Toronto, Canada) and the Amsterdam UMC, location AMC (The Netherlands). In both locations, the ORBB was in use. Between September 2016 and July 2018, 117 elective laparoscopic procedures were recorded using ORBB. The Surgical Team Assessment Record (STAR) questionnaire was administered in both centers. 29 This questionnaire investigates the Human Factors Analysis and Classification System (HFACS)’s four levels of human failure, including organizational influences, unsafe supervision, preconditions for unsafe acts, and unsafe acts. 30 In total, 507 questionnaires were completed, of which 230 (91 cases) were completed at St. Michael’s Hospital (SMH) and 277 (35 cases) at the Amsterdam UMC. In total for both sites, 119 questionnaires were completed by staff surgeons, 96 by surgical residents, 76 by surgical fellows, 78 by the anaesthesiology team members (including anaesthesia nurses), 41 by scrub nurses, 44 by circulating nurses, and 53 by medical students. Surgical fellows rated their personal readiness significantly lower, compared to the rest of the team. This may be in part caused by stress surrounding career choices and