Anne van Dalen

258 I Summary and General Discussion and leadership, on team performance. Also, to define what type of human factors are most relevant and valuable to incorporate in team-based training focusing on improving surgical safety. Lastly, Chapter 7 assessed the OR staff’s attitudes towards our patient safety culture, and whether participation in the ORBB team debriefings may have affected their safety behaviour. Understanding the needs, attitudes and perceptions amongst healthcare professionals working in the OR is key in improving future surgical safety. 38 41 The Dutch version of the validated Hospital Survey on Patient Safety Culture was used and ten questions regarding the use of theORBB were added. 42 In total, 126 professionals working in our OR complex completed the survey. Overall attitude towards patient safety was scored with a mean of 3.06 (SD 0.46), 5-point Likert Scale, PRR 23.81%). The operating nurses rated the overall perception of safety the lowest (mean 2.89 (SD 0.45)) while the anaesthesiology residents rated it to be the highest (mean 3.39 (SD 0.32)). Teamwork within the department was rated the most positive with an overall mean of 3.69 (SD 0.64), Positive response rate 73.02%), followed by communication openness (mean 3.60 (SD 0.76) Positive response rate 63.49%). Overall, the attitude of professionals who participated in surgical team debriefings using the ORBB was positively correlated with the overall perception on patient safety (P-value < 0.024, 95% CI 0.034-0.474, Bèta-coefficient 0.196). In line with previous (HSOPSC) studies, this study indicates there is still a variety in perception of the safety culture in the OR between the different OR professionals. 43 44 A strong safety culture is based on a shared mental model of peri-operative situations, but can only be established when beliefs, opinions, needs and attitudes on surgical safety can be safely expressed and discussed amongst members of the OR team. 38 45 Errors ought to be managed in a ‘ just culture’ instead, where all team members (from residents to nurses) feel confident and are encouraged to report events (even their ownmistakes). 46 47 48 Collective accountability needs to be promoted, as healthcare professionals take care of patients as teams, err as teams, and need a way to accept accountability as teams. 49 Healthcare organizations have therefore the responsibility to implement non- punitive reporting systems and to support clinicians when errors occur. 49 Yet, to create a