Anne van Dalen

Summary and General Discussion I 269 including annotated video segments of interest while protecting user privacy (i.e. faces are blurred, voices are altered). To date, the OR Black Box ® user network has grown to various other medical centres world-wide. 102 External or hospital funding should support the educational project, as the use of a Black Box for postoperative team debriefing is a data-driven quality improvement initiative. New research lines should focus on change of safety behaviour (i.e team debriefing and training), how to build stronger teams based on the identified safety threats (e.g. human factor skills, distractions, equipment failure), and its impact on patient outcomes. TheSixSigmamethodology alsoemphasizes theneed for a structureddata-driven strategy, focusing on reduction of variation and process improvement. 66 Nevertheless, the OR remains an environment that often lacks comprehensive data capture, robust monitoring strategies, and process evaluation. Consequently, OR professionals are not able to fill the knowledge gap on perioperative process optimisation. 10 Yet, Six Sigma performance may only be achieved by creating a continuously monitored OR, capturing natural behaviour and standard operative processes, in order to define both the technical (i.e. technology, managerial, or engineering) and non-technical (i.e. human) factors possibly affecting patient safety. 103 Future studies should evaluate whether the use of the proposed debrief model in video-assisted team debriefing may actually change the behaviour of the participating team members. Scheduling the multidisciplinary debriefings for such an amount of consecutive surgical cases with so many different OR team members proved to be challenging. Although the results of this thesis showed that neither the number of team members attending the teamdebriefing, nor number of workdays between the procedure and debriefing was significantly associated with the satisfaction scores, it is recommended to invite OR personnel to participate in about 1-3 multidisciplinary debriefings per year. Besides that, the team itself should be able to request a Black Box debriefing if wanted or needed. If a calamity occurs, the team should also be able to request the anonymous Black Box performance report, to augment to the calamity analysis. Whether or not it is widely generalizable to have an independent person, such as a professor of psychiatry, moderate the sessions and the cost-effectiveness remains open to discussion as well.