Marlot Kuiper

132 Connective Routines Writing down the names of team members on the board will strengthen connections between routine participants on the long term: “We are such a large hospital that it is impossible to know everybody by name. In that respect, just reading the others’ names on the board makes it easier. If I don’t have to ask, “hey you, can you give me that ampule” it becomes easier to communicate, and I am more inclined to ask more personal stuff like “how was your weekend,” you see?” Writing down the names serves a broader purpose — it does not only mean that teammembers basically know each other’s names, but it is also an attempt to form more in-depth connections that could lead to more shared understandings, and thus ultimately, safer practices. These views that reflect different understandings of the ostensive dimension of the time-out, rooted in a focus on either the direct goal – performing a surgery - or long term – creating firmer team connections, explain differences in the performative dimension. 5.3.2 Hierarchical positions The performance of the checklist requires interaction among the various team members. Every individual participating in the teammust be able to communicate about the various items and ‘pause’ the process in case the requirements of items have not yet been met. The findings show that for creating such connective patterns of action, the hierarchical position matters. The following observation note reflects the performance of a time-out procedure in the general surgery department. Time-out The resident in surgery does the time-out with the patient. The checklist poster is put up prominently in the OR. The resident asks for the patient’s name while checking his wrist ID, after which he asks the patient to describe the surgery in his own words and name the surgical side and site. Resident in surgery: Okay, perfect. And you have no allergies, no. Do you have any questions left for us, sir? Patient: [nodding] Resident in surgery: No? Okay. We’re gonna take care of you, sir. Let’s start. Scrub nurse: [mumbling] And we all live up to hygiene protocol.