Anne van Dalen

70 I Chapter 2 summarizing, and by letting the team members do most of the talking. 87 In that way, all participants may develop a high level of reflection by creating their own conclusions and motivation for change. 11,88 It may be advised to schedule debriefings outside the immediate OR environment on a round table setup, so the team can sit comfortably, on eye level, and be on neutral ground with one another. 8,9,11,46 Beepers and telephones might be muted or tucked away. Having a coffee or a snack when debriefing with the team may help to relax and facilitate the atmosphere. When using an MDR, a summarized performance report based on validated rating scales is recommended for both logistic and informational seasons. Such output may include specific and condensed feedback on all identified relevant positive and negative events. 24,89 It may be recommended to focus on the nontechnical aspects, such as communication rather than individual technical events, as this might be more educational than debriefing individual technical skills. 90,91,92,93 The NOTSS and SPLINTS rating scales may be used for this purpose. By integrating AI and machine learning software, the video and medical data output can be largely automatically analyzed, sparing the involved health care professionals’ hours of looking back at video footage. 23,94 An example of the new OR Black Box performance report that uses these ratings scales and AI to analyze the video and medical data recordings is demonstrated in Figure 3. The surgical procedure is summarized in one overview slide. By clicking on the purple or blue diamonds or red circles, the video-augmented feedback regarding intraoperative event is shown (see black arrow and popped-up screen). Hospital directorates who support participation of debriefings can facilitate in allocating time, making it possible to attend the debriefings preferably in normal working hours. It may also be advised to plan the debriefing not immediately after the surgical procedure, but within a time-span of some days, as direct “hot” debriefing is often not practical in the workplace. 2,44 This time span gives the operating team some time to process and “wind down” and in case of video recording, to optimize the supporting performance report. 31,87,95