Anne van Dalen

270 I Summary and General Discussion Multi-centre studies, on larger scale, across settings using (different types of)medical data recorders providing output supporting team debriefing and team training are therefore needed. Patient related outcome data ought to be included. Also, to strengthen the degree to which suitable inferences can safely be drawn about the impact of behavioural monitoring using video recorders on human factor skills, patient safety behaviour and safety culture. Conclusions Being able to look back on shared performance in a safe, neutral and moderated setting helps all team members to get a clearer perspective on peri-operative situations. This ensures a productive, healthy and safe working environment, which focusses on education and rehabilitation rather than blame and shame. Systematic postoperative team debriefing using a Black Box, led by an independent facilitator, supports objective assessment of safeety threats that have traditionally been ignored, creating an unique opportunity to discuss appropriate solutions with the entire OR team. Quality improvement initiatives, such as the Black Box system, therefore need to be supported by the healthcare organisation, and above all involve the entire OR team, to create more transparency concerning error management and a shared belief that engagement leads to an even better safety culture in the operating room.