Anne van Dalen

Summary and General Discussion I 257 joint the Theatre Cap Challenge, initiated an Australian anaesthesiologist. 36 This initiative emphasizes the importance of visible staff identification, by putting your name and role on your surgical cap while working in the high-risk operating environment. The name and role sticker stations have been placed at the dressing rooms in the operating complex. The OR staff was notified accordingly and were asked to wear the name stickers on their surgical caps. Participation was voluntary. Board members and team leaders acted as role models. About one year after implementation, we evaluated how many were actually wearing the name stickers. We found that on average almost half of the OR staff (44.8%, n=103 out of 230 observations) was now wearing the stickers and of this randomly observed sample, 17 (16.5%) were a surgeon, 29 (28.2%) were OR nurses, 31 (30.1%) anaesthesia nurses, and 15 (14.6%) were medical interns. Staff may have been derisive at first, throwing remarks upon colleagues “So you can’t even remember your own name, can you?” or “That looks silly, I am not going to do that”. Nevertheless, those eventually did wear them commented; “it looks silly, but it works”, “I feel more part of the team when I am certain that everybody is able to use my name”, and “it is useful, because especially during stressful situations names are forgotten”. Although some may not see or understand the power of something as simple as using one another’s name, it is generally known that people feel more appreciated and are happier to help if you call them by their name, enhancing coherency of the team and improve surgical safety. 37 Patience and role modelling by leaders showing the way with using the name stickers is important. 38 39 Future studies are needed to evaluate the impact of putting your name on your surgical cap on the use of the CLC technique and subsequently the incidence of adverse events caused by miscommunication in the OR. Overall, a deeper understanding of the etiology and effect of personal factors (i.e. crew resource management and personal well-being) on team performance may lead to more targeted and sustainable quality improvement initiatives. A supportive team-based approach is therefore recommended, to limit the amount of unnecessary safety threats during a surgical procedure. 26 40 Future studies are needed to elucidate the impact of human factor behaviour in the OR, such as closed-loop communication