Anne van Dalen

3 Implementing structured team debriefing using a Black Box in the operating room I 99 DISCUSSION This study focuses on the satisfaction of the OR team with the use of a new monitoring system, the OR Black Box®, and its subsequent output used in team debriefing. This outcome was chosen because for people working in the OR it is vital to feel comfortable and secure, in order to be able to adopt such an innovative system. The team has to be satisfied with a system that ‘watches’ and ‘ judges’ them. Only then, a quest to learn from unnoticed or differently perceived errors may take place. 32 Overall, satisfaction of the surgical team with the use of the OR Black Box® and corresponding outcome performance report for postoperative structured team debriefing was very high. Ninety-eight percent of participants would recommend postoperative multidisciplinary debriefing with the use of the OR Black Box® derived output to their colleagues. Although team debriefing is not yet common practice in most hospitals, participating surgical team members have considered structured team debriefing to be important, useful, and educational. 17, 33–37 These results show that number of previously attended team debriefings is positively associated with user satisfaction. This implicates that there is no ‘wear out’ of participating to debriefing, in contrast. One may even argue that new users over time become bigger advocates for the debriefing, using the system for this purpose. The type of procedure, years working at the hospital and age did not seem to influence satisfaction, suggesting that there is no extinguish of participation interest and that bias due to the ‘novelty effect’ is minimal. 38 This is an encouraging finding, when implementing innovations in the operating theatre. 39, 40 As to be expected, the primary surgeons, drivers of the initiative, were significantly more satisfied than the participating assisting surgeon, anaesthesiologist and OR nurses in the surgical team. The phenomenon of perceived difference of perception about the same situation between the surgeon and other teammembers is acknowledged in literature. 41–43 It may also be contributed to the so-called ‘Rashomon’ effect, which occurs when the same events is described in significantly different ways by different people who were involved. 44 Indeed, based on the respective roles, disagreements exist regarding the evidence of events in the OR. Also, subjectivity versus objectivity in perception, memory and reporting is in play, when looking back upon situations. Surgeons,