Anne van Dalen

256 I Summary and General Discussion stability. Other factors known to influence staff well-being include workload, climate, or perceptions of teamwork. Negatively affected personal well-being, expressed by for example emotional exhaustion, fatigue and an inability to concentrate, may hinder one’s capacity to ensure surgical safety. 15 31 32 Hence, promoting staff well-being may serve to improve teamwork, organizational outcomes and consequently surgical safety. Staff surgeons identified distractions (51.3%, n = 61) and aberrations (60.5%, n = 72) during surgery more often, compared to the other teammembers. These were usually related to technological issues. Although distractions or aberrations during surgery are inevitable, they can be detrimental to overall team performance. Each team member may have a different sense of what is a distraction or aberration, and thus act differently in identifying or reporting these. Yet, highly cohesive teams may support the expression of individual opinions, which may promote identification of these distractions or unsafe acts. 33 If unsafe acts are identified pro-actively, this may mitigate peri-operative errors, as these are usually the result of a cumulation of minor aberrations resulting from different factors in the OR. 12 The crew resourcemanagement principles are adopted from the aviation industry and incorporated in the HFACS model, as these principles emphasize the importance of using the closed-loop communication (CLC) technique in order to prevent unsafe acts. 34 The CLC technique includes 3 components; 1) an initial message that starts with stating the name of the recipient, known as directed call out, 2) verification by the named recipient, including repeating the critical aspect of themessage, known as check back, and 3) verification by the message sender that the recipient has interpreted the sent message correctly, known as closing the loop. Accordingly, the WHO Surgical Safety Checklist briefing includes an introduction stating name and role of all team members before start of the surgical procedure. 35 During the ORBB team debriefings, the participating professionals realized how difficult it is to recall one another’s name. Even when they had worked with the same team members multiple times before. In Chapter 6 we introduced a simple solution to support the use of the CLC technique. As we discovered that just “checking the box“ of the Surgical Safety Checklist does not mean the check has actually been performed and may not suffice to remember the roles and names. We therefore