Marlot Kuiper

131 How standards work out in medical teams: On routine dynamics 5.3 Improving collaboration An explicit purpose of implementing the checklist in Plainsboro was to improve teamwork, at least from the perspective of the hospital board and the ‘frontline leaders’ from anaesthesia. With more than twenty operating theatres, this large teaching hospital not only has a significant labour force but also a high staff turnover, since multiple employees come and go for educational purposes. As a consequence, the ‘teams’ vary, and people operating together who have never met before is quite ordinary. In order to familiarize teammembers with one another, the SSC not only includes checks concerning patient identity and intervention but explicitly stipulates that team members introduce themselves before a case by writing their name and function on the whiteboard. 5.3.1 Direct goals and beyond Halfway the period of episodic observations, several ‘time outs’ had passed by during the days at the various theatres in the general surgery department, and in all these instances, the time-out was performed in ‘some kind of way.’ Mostly, the first items were systematically checked (patient identity, intervention, allergies), while other aspects were often more loosely applied and in varying sequence. Every now and then, the names of teammembers were on the board. However, if any mutations in the team composition occurred, this was not adapted. Moreover, there seemed to be no attention for or vocal confirmation of the names on the board at all. I wondered how this pattern of ‘selective’ performance emerged; the first items were systematically and consequently checked, whereas the items striving for stronger connections were—if at all—more ‘loosely’ applied. During a coffee break, a conversation about such selective performance started, and ostensive ideas about the checklist surfaced. Professionals often do attach importance to the time-out procedure, yet some items are considered more important than others. Writing down the names of all the team members, for example, does not add to the safety and quality of the specific surgery performed is the dominant conviction. In other words, there mostly is a focus on the direct goal — performing a high quality surgery — and with regard to that, writing down the names of the team members is not immediately considered to attach value to the quality performance of the operation. However, a conversation with an anaesthesiologist brings forward a different version of the ostensive dimension that emphasizes in-direct, long term effects. 5