Anne van Dalen

Summary and General Discussion I 271 KEY POINTS OF THIS THESIS • It is possible to implement a video- and medical data recorder in the operating room in accordance with the local legal, ethical and privacy related guidelines • A debrief model was developed and may be used to facilitate video-assisted postoperative debriefing in a structured, non-hierarchical and safe manner • The participants of the Black Box procedures and following debriefings considered it to be both beneficial and important and would highly recommend participation to their peers • Both safety threats and resilience support events identified by the Black Box were most often related to the interaction between members of the team • During the postoperative multidisciplinary debriefings, events related to communication and situational awareness were most often discussed by the team • The use of name stickers on the surgical cap may help use the closed-loop communication technique to improve communication skills in the operating room • Participation in the Black Box debriefings may have a positive impact on safety behaviour by providing the opportunity to discuss differences in perception concerning patient safety • A team-based approach, with full support of the organization, is recommended when implementing a quality improvement initiative such as the Black Box • Artificial intelligence software, integrated in the Black Box, may help optimise surgical decision making, improve workflow, and ultimately surgical quality and patient safety • The use of the Black Box following the Six Sigma strategy may support process optimisation and therefore help improve the safety culture in the operating room