Anne van Dalen

264 I Summary and General Discussion in normal working hours. It is also advised to plan the debriefing not immediately after the surgical procedure, but within a time-span of some days, as direct “hot” debriefing is often not practical in the workplace and it gives the team some time to process and “wind down”. 74 A summarized performance report based on validated rating scales (such as the NOTSS 75 , ANTS 76 and SPLINTS 77 ) is recommended for both logistic and informational reasons. Therefore, the Black Box performance report that was used includes specific and condensed feedback on all identified relevant positive and negative events. 26 It is recommended to focus on the non-technical aspects, such as communication rather than individual technical events, as this is considered more educational for the team than debriefing individual technical skills. 78-80 By integrating AI and machine learning software, the video and medical data output can be largely automatically analysed, sparing the involved healthcare professionals hours of looking back at video footage. 57 81 Perspectives of the participants For people working in the OR it is vital to feel comfortable and secure, in order to be able to adopt an innovative system such as the Black Box. The team has to be satisfied with a system that “watches” and “ judges” them. Only then, the team can learn from unnoticed or differently perceived errors. This thesis concluded that the overall satisfaction of the OR teamwith the use of the Black Box and corresponding performance report for postoperative structured team debriefingwas high.Ninety-eight percent of participantswould recommendpostoperative multidisciplinary debriefing with the use of the Black Box and its performance report to their colleagues. 51 As to be expected, the primary surgeons, drivers of the initiative, were significantly more satisfied than the participating assisting surgeons, anaesthesiologist sand OR nurses. The phenomenon of perceived difference of perception about the same situation between the surgeon and other team members has been highlighted in the current literature. 82,83 The so-called ‘Rashomon’ effect may have been of influence as well, which occurs when the same event is described in significantly different ways by