Anne van Dalen

28 I Aim and outline of this thesis AIM AND OUTLINE OF THIS THESIS The aim of this thesis was to implement the OR Black Box®, a video- and medical data recorder, in the operating room (OR). The OR Black Box (ORBB) was designed as a data-driven quality improvement initiative. It records a medical surgical procedure and generates an outcome report based on events regarding technical and non-technical skills. The outcome report was then used for multidisciplinary debriefing. This thesis will evaluate the implementation process, the outcomes of the debriefings, and factors that may contribute to improving surgical quality and patient safety in the operating room. Part I: Implementation of the OR Black Box in the operating room The first part addresses the important aspects, pre-requisites, and hurdles of the implementation of the ORBB. It investigates the important gaps in the current literature towards implementing postoperative team debriefing with the use of a ORBB and its outcome report. In Chapter 1 themedicolegal andprivacy perspectives on the use of video- and medical data recorders in the operating environment are evaluated. Lessons learned from the aviation safety system perspective are evaluated as well. The key dimensions and our practice recommendations concerning legal implications are presented. Chapter 2 provides an overview of the current medical literature regarding debrief methods and models that could be of value to use for post-operative video-assisted team debriefing. A true debriefing culture in surgery is lacking to date. At the start of this project no debrief model fit for use with any video- and medical data recorder existed. We therefore developed a standardized debrief model to be used for the ORBB debriefings. Part II: Increasing transparency in the operating room The second part investigates the use of the ORBB, its performance report, and the standardized team debriefings to create more transparency in the OR and support the participating members in doing so. Overall, the results of the Transparency in the Operating Room (TOPPER) trial are presented. In Chapter 3 the satisfaction of the participating operating team members regarding the use of the ORBB and its performance report for team debriefing is evaluated. Chapter 4 assesses the outcomes of the performance reports and the debriefings. Common safety threats and resilience