This qualitative study sought to identify barriers and enablers influencing stakeholder support of the Operating Room (OR) Black Box, an audio-video recording device similar to that used on airplanes. Stakeholders were mostly supportive of the OR Black Box, but several potential barriers were identified, such as time pressures in the OR and perceptions that the Black Box may negatively impact clinical performance. Authors concluded that the OR Black Box must be positioned as a patient safety initiative to improve practice.