Anne van Dalen

Summary and General Discussion I 267 up, and team members know what is to be expected. 40 For this, a high level of individual human factor skills is required. Several important human factor skills may lead to peri- operative unsafe acts, such as personal readiness, distractions, and communication between the team members. 12 30 However, the impact of such unsafe acts is not always evident nor apparent to the team, and OR team members may have discrepant attitudes about the level of human factor skills exhibited from one another. Discrepancies may be caused by differences in status or authority, responsibilities, and culture. 12 22 30 93 Surgical fellows rated their own well-being significantly lower than the surgical residents, which may be caused by stress surrounding career choices and stability. Other factors known to influence staff well-being include workload, mental stress, climate, or perceptions of teamwork. 94 These human factor elements are associated with burnout symptoms, job satisfaction and organisational commitment. Burnout symptoms, such as emotional exhaustion, fatigue and an inability to concentrate, hinder one’s capacity to ensure high performance. 15 Hence, it is important to promote staff well-being, as it improves human factor skills, organisational outcomes and consequently patient safety. Distractions or aberrations during surgery are inevitable, but they can be detrimental to overall team performance. Each team member has a different sense of what is a distraction or aberration, and thus act differently in identifying these possible threats to patient safety. Therefore, individuals vary in feeling the urge or responsibility to alert the team on a perceived distraction or aberration. The importance of awareness of communication skills in the OR ought not to be underestimated either. Increased use of the CLC technique (i.e. using each other’s name) reduces unnecessary miscommunication, provides opportunities for clarification of safety-critical information, and enhances the OR team’s shared mental model. 95 Yet, participants of the Black Box study realised how difficult it apparently is to remember each other’s names. There are many reasons why people find it difficult to remember each other’s names, even when the names are introduced prior to start of the procedure, are written on a whiteboard and when team members have worked with one another multiple times before. Therefore, implementation of the use of name stickers or plates in the OR is recommended, as it may facilitate the CLC technique in a simple manner.