Marlot Kuiper

101 On Ethnography ing Box 1: The Surgical Safety Checklist The world health Organization (WHO) launched its ‘Safe Surgery Saves Lives’ campaign in January 2007. The main goal of the campaign was to improve the safety of surgical care around the world, by decreasing unwanted variety in surgical care and improve teamwork within the operating theatre (Haynes et al. 2009). One of the final outcomes of this program, was the Surgical Safety Checklist. Data suggested that at least half of all surgical complications are avoidable (Donaldson, 2007;WHO 2008). Previous efforts to implement checklists to reduce complications, such as a checklist to reduce central line infections, had shown positive effects (e.g. Pronovost et al. 2006). Further, a growing body of literature linked teamwork in surgery to improved outcomes (Capella et al., 2010; Epstein, 2014; Russ et al., 2013; Schraagen et al., 2010). Based on these findings, the Surgical Safety Checklist was designed after extensive consultation of a multi-national team of surgeons and anaesthetists (WHO 2008). The WHO checklist is a concise, single page list divided in three parts; (1) a sign-in before anaesthesia, where crucial items such as patient identity, planned procedures, required materials, and known allergies are discussed in interaction with the patient, (2) a time-out just before incision of the skin, when again crucial items have to be confirmed by the team members, and (3) a sign-out where important items have to be checked before the patient leaves the operating theatre, for example if all gazes and needles have been removed, and where teammembers have to agree upon and register proceeding therapies (figure 3). The developers of the checklist had several aims when developing the checklist. First and foremost, the checklist should improve patient safety by reducing surgical mistakes. Next, the checklist should enhance inter-disciplinary teamwork and communication in operating theatres. The artefact embodies thus both notions of a ‘memory aid’ and a ‘team intervention’. It is important to emphasize that ‘team work’, or ‘the creation of connections’ is woven into this checklist in different ways; first, the checklist explicitly stipulates that team members introduce themselves before surgery. Further, in the performance of the checks team members rely on each other’s information, they thus have to perform the checks in interaction with one another. 4