Marlot Kuiper

130 Connective Routines the hospital is “working on it”. Interestingly enough, as no further details are given on how Plainsboro aims to translate the collaborative strategy into daily practice, the goal to “optimize processes”, is repeated several times throughout the module and appears as one of the organisations’ primary goals. Remarkably, as new employees we are directly spoken to when it comes to ‘optimizing processes’. The board member explicitly invites us to send him an e-mail in case we encounter something “odd” or are amazed by what we see, since “fresh eyes” are very helpful in “breaking through routines.” The audience responds with laughter, as if people do not take this offer quite seriously. “As if he has the time to read it” my neighbour whispers to me with a smile. At least, unravelling routines in this hospital is exactly where I - as a research assistant - came for. Optimizing processes is also an important focal point for Plainsboro for the sake of accreditation. The implementation of the Surgical Safety Checklist has been just one of about 1400 standards that have been implemented aimed at improving quality of care, research and education, and herewith achieve a renowned international accreditation. The fact that Plainsboro received this accreditation – about 2,5 years before this module for new employees takes place – doesn’t go unnoticed, as it is being repeated by several speakers throughout the meeting. Throughout the 4-hour-during meeting, the hospital has already signalled various diverging goals of standards to us that have been or will be implemented; improving collaboration, reducing mistakes, optimizing processes and maintaining high-ranked accreditation. Goals that are not congruent per se, and therefore not necessarily require the same approach. Moreover, these different abstract patterns embodied in the same artefact – the Surgical Safety Checklist – might fuel conflicting performances. In creating social connections between team members for example, team performances could be at the forefront, whereas in maintaining a high-ranked accreditation ‘ticking the boxes’ is of great importance. This dynamic interplay of ostensive and performative dimensions comes to life in working with standards at the frontline. The coming paragraphs all depart from one of the three ‘basic’ understandings i.e. abstract patterns of the checklist: improving collaboration, reducing medical mistakes, and maintaining accreditation. I will show how these ‘basic’ understandings actually are multiple, contested, understandings.