Marlot Kuiper

127 How standards work out in medical teams: On routine dynamics this, role taking, hierarchy and connective potential matter for how ostensive understandings can fuel performances. The empirical findings feed into a model of routine dynamics in highly professionalised settings. 5.2 The envisioned routine Plainsboro Teaching Hospital had introduced the Surgical Safety Checklist in 2009, after both the public opinion and health authorities had urged hospitals to implement such checklists in perioperative care, not in the least since there had been severe media attention for incidents. The Dutch Health Care Inspectorate mandated nationwide perioperative checklist implementation 1 in 2008, and nowadays measures compliance through registration data and side visits. In implementing the checklist in Plainsboro, the aviation industry was looked at as a success case. In this domain, checklists had been successfully implemented to enhance teamwork and improve handovers, and thereby minimized avoidable errors. The example of the aviation industry is even visualized on the front cover of one of the policy documents regarding the Surgical Safety Checklist: surgical teammembers are handing over information in a simulation cockpit of an airplane (figure 8). Even though the WHO Surgical Safety Checklist format was designed in a consensus project including both surgeons, anaesthesiologists and assistants (see chapter 4), the authors indicated on the policy document in Plainsboro are a nurse anaesthetist, and two senior professors in anaesthesia. With professor Slemmer, I had an extensive conversation about the checklist and its implementation. Professor Slemmer was greatly enthusiastic about the checklist, and he made improving surgical care his core ambition for the final years of his career. In preparing the implementation of the Surgical Safety Checklist, the ‘implementers’ or ‘frontline enthusiasts’ like professor Slemmer drew inspiration from documents designed by international colleagues, such as the “General guidelines for assessing, approving and introducing new surgical procedures into a hospital or health service” by the Royal Australasian College of Surgeons (RACS). Despite this support in implementing new procedures, professor 1 This might be the Surgical Safety Checklist, or any other perioperative checklist, such as SUR- PASS. I refer to paragraph 2.3.1 for a detailed description of safety checklists. 5