Anne van Dalen

Summary and General Discussion I 265 different people who were involved. 84 Indeed, based on the respective roles of the team members in the OR, disagreements exist regarding the evidence of possible adverse events. Subjectivity versus objectivity in perception, memory and reporting is in play as well, when looking back upon situations. Besides that, participants were asked to voluntarily participate in the Black Box project, so it was to be expected that they would be satisfied with the Black Box debriefings. Thismay have introduced a positive selection bias. However, at the start of the project, only a few anaesthesiologists and nurses felt comfortable enough to participate. Interestingly, their participation numbers kept on growing steadily in the study over time. An effect that can be contributed to the fact that several healthcare professionals who were initially unsure or even quite sceptical towards the initiative decided to participate in the team debriefings during the trial based on positive experiences shared by their colleagues. When these second group of adopters overcame their initial scepticism and came to understand how their privacy was protected, they reverted their opinion due to actual user experience. 85 Eventually, initial laggards became the most important drivers and advocates for the Black Box project. 51 Observations by the OR Black Box This thesis highlights the importance of clear communication in the OR, as the most often discussed events during the team debriefings were related to communication and situational awareness. 86 These results are in line with other studies that used video recording in the OR, also demonstrating that communication is generally the root-cause of adverse events. 87-89 Therefore, team debriefing appears to be vital, as it was only during the postoperative debriefings that the team members realised the important impact of miscommunication. 86 Moreover, team debriefing can drive the quality improvement process by identifying, and most importantly, addressing and discussing recurring, new or unrecognized safety issues. 3 90 Traditionally, OR teams are hierarchical, often discouraging team members to speak up to or confront a teammember. 48 91 Yet, participants indicated that the Black Box debriefings provided them with the opportunity to “speak up” more easily. Other factors