Anne van Dalen

268 I Summary and General Discussion Improving human factor skills in the OR requires a change in safety culture, which takes time and commitment. In line with previous studies, this thesis indicated there is a variety in perception of the safety culture in the OR between the different OR professionals. 43 44 This remains to be a significant challenge for safety improvement initiatives. A strong safety culture is indeed based on a shared mental model, which can only be established when beliefs, opinions, needs and attitudes on surgical safety can be safely expressed and discussed amongst all the members of the OR team. 38 45 The goal of improving the safety culture is aimed at encouraging all OR team members to be transparent about issues that may impact patient safety. 33 48 Therefore, healthcare organisations need to consider not only the behaviour of the OR team, but also the complex interrelationships between culture, technology, and achieving reliable, high-quality patient outcomes. 96 97 Future perspectives In the future, societymay decide to choose transparency over themedicolegal and privacy concerns of the OR team and demand full legal access for the patient to the information generated by a Black box. 27 98 In the USA 99 and Korea 100 , legislation is begin drafted to require continuous video recording in the OR and to allow patients to access these video recordings, aiming to prevent malpractice. If future legislation were to support the position that video recordings become part of standard care, healthcare professionals are bound to work in a continuously monitored OR, where all results are accessible to patients. This is an argument for healthcare professionals and organisations to start exploring optimal use of a Black Box, to secure optimal conditions for both patient and providers, as soon as possible. To secure optimal conditions, future studies are needed to evaluate the feasibility, deployment and generalizability of such video recording systems across different operating environment settings. AI and machine learning software needs to be used to facilitate efficient analysis of the multisource big data achieved from the OR, based on the before mentioned validated rating scales. 101 The OR Black Box system that was implemented and used in this thesis, now creates a video-assisted and AI- based outcome report that provides comprehensive, detailed, and objective feedback