Technological developments in the medical world introduce a shift in responsibilities of the surgical team members which might result in waste of talent and skills. The latter might result in disengagement and decreased productivity and thus in illness-related absenteeism. The people pillar of sustainability aims to create a healthy workplace and thus to manage illness-related absenteeism. The objective of this research was to optimise the responsibilities of the surgical team members in minimally invasive surgery (MIS) in order to achieve a balanced and sustainable employability of the surgical team to counteract waste of talent and skills. Empirical data was collected in two different steps. In the first place, an overview of the surgical phases during the MIS procedure and an overview of the tasks performed by the perioperative nurses were made. In the second place, two different methods were used to obtain data. First, seven video recordings of a laparoscopic gynaecological procedure were analysed to obtain the distribution of the responsibilities and the percentage of (technical) tasks for each phase and the entire MIS procedure. Second, interviews with fourteen perioperative nurses were conducted to map the peak moments of a MIS procedure and to evaluate the impact of the technological developments on the nurse's workload. As a result, a fluctuation of the total duration of all tasks during the procedure was shown. A percentage higher than 70% was measured in the start phase. The perioperative nurses experienced low peak moments during 66% of the entire surgical procedure. A high impact of the technological developments was experienced by the nurses. The physical activity for MIS and robot-assisted surgery (RAS) was lower than a conventional open procedure (OS). The total duration of the technical tasks was highest in the second phase of the MIS procedure. The nurses indicated that this phase took longer compared to the same phase in OS procedures because of the amount of equipment that has to be connected. In conclusion, an unbalanced employability was recognised during MIS and technological developments had a high impact on the activities of the perioperative nurses. This research has several recommendations. First, a more sustainable employability will be achieved when two perioperative nurses will be scheduled for three surgical procedures during 66% of the MIS procedure. Second, deployment of a technical perioperative nurse will decrease the amount of workload. Last, by giving the perioperative nurses more responsibilities in MIS, the talent and skills will not be wasted leading to a more balanced employability of the surgical team members.

Hospitals are facing enormous financial pressure over the last years. To achieve lower costs, hospitals should invest in smart ways of working to make optimal use of the scarce capacities. A solution can be digitising processes in the hospital to prevent it from making more costs. In line with this founding, planning and scheduling of the operating room (OR) program during a day is a process that could be improved by digitising. Overtime and idle time are consequences of inaccurate planning and are both expensive elements that do not contribute to satisfaction of hospital personnel and patients. Radio Frequency Identification (RFID) is proven and proposed in previous research to be used to acquire data for surgical phase detection. Up until now, the detection accuracy for this model is too low and requires optimization before it can be implemented in the OR. This research uses a systematic approach to investigate the feasibility of implementation of RFID in the OR in Reinier de Graaf Gasthuis (RdGG) in Delft for the purpose of surgical phase recognition. The systematic approach is divided in four parts: theory, design, testing and evaluation. The first part presents an analysis of the OR in RdGG and the RFID technology and is used in the design part to compile a list of of design requirements. This list presents criteria that must be met in order to achieve succesful implementation of RFID in the OR. Based on the requirements an optimal position of the antenna is chosen above the surgical table, in the center of the plenum ventilation area and on a distance of 1.5 meter of the surgical table. On the basis of the optimal antenna position, an antenna, tag and reader is chosen. The proposed RFID system is tested in the MISIT-lab at the TU Delft and in an OR in RdGG. The goals of the experiments were to visualise the detection field and to compare the effect of the environment on the RFID performance. In the MISIT-lab, the antenna was able to detect a vast majority of tags up to a perpendicular distance (from the antenna to the surgical table) of 1.3 meter. At longer distances of 1.4 and 1.5 meter the antenna was still able to detect tags but to a lesser extent. The OR experiment yielded poor results compared to the laboratory experiment. None of the tags was detected on the predeterimined distances. The antenna was only able to detect tagged instruments on a distance of approximately 0.8 meter. The results are evaluated in the last part of this research. Normally, when facing poor performance of an RFID system the performance can be improved by increasing the antenna gain or choosing stronger RFID tags. These choices are both constrained by the dimensions of the antenna and the tag. An RFID antenna with a large surface cannot be placed in the airflow above the surgical table because this increases the risk on infections and large RFID tags do not fit on surgical instruments. The most probable reason for the decrease in performance between the two experiments is electromagnetic noise from surrounding electrical equipment and wires in the floor and ceiling. In conclusion, it is not possible to implement an RFID system in the OR for phase recognition purposes. RFID technology is fast evolving and new technologies can offer a solution. It is certainly possible that RFID can be implemented in the future when tags and antennas are more powerful while retaining small dimensions. In future, it is recommended to perform on site tests of RFID in the OR before further developing an application.