Anne van Dalen

29 I Aim and outline of this thesis support events identified by the ORBB are described. Notes from the discussions around these events during the team debriefings are evaluated. Lessons learned by the team and what to improve regarding non-technical skills is highlighted. Part III: Improving surgical quality and safety in the operating room The third part elaborates more on the intraoperative factors that either threaten patient safety or support system resilience during general laparoscopic surgery, as highlighted in Chapter 3 and 4. In Chapter 5 the perceptions of the team members concerning human factors, such as communication and situational awareness in the operating room is assessed. Differences in those perceptions are evaluated. In Chapter 6 the importance of certain communication skills, like the closed-loop technique, in the operating environment are discussed. The implementation of the use of name stickers in the operating complex is evaluated. Chapter 7 evaluates the attitudes of the various healthcare professionals working in the operating room towards our patient safety culture. And, the impact of participation in the Black Box team debriefings on their safety behaviour. Part III: Future use of the OR Black Box in the operating room Finally, perspectives on the future of the use of the ORBB are demonstrated. The ORBB collects complex big data sets to reveal patterns, trends, and associations, especially relating to human behaviour. Big data has the potential to become progressively useful in both guiding surgical care and optimizing workflow and clinical patient outcomes, if handled well. The ORBB system uses artificial intelligence (AI) and machine learning software to handle big data collection and analysis, as traditional data processing techniques are not able to handle these vast amounts of complex data. AI has just now made its introduction into medicine, and even more recently, into the OR. In Chapter 8 the current applications of AI inside the OR are systematically reviewed and presented. In Chapter 9 the importance of focusing on improving the safety culture to reduce errors in the OR is highlighted. Therefore, the Six Sigma strategy is introduced and how to follow this with the use of the ORBB to create an even safer culture in the OR.