Marlot Kuiper

133 How standards work out in medical teams: On routine dynamics The scrub nurse starts writing down the names of all team members on the whiteboard. In this specific performance of the time-out, the first items of the checklist were consistently checked in interaction with the patient. However, the surgeon performing the checklist finishes the procedure by checking for allergies and herewith neglects, for example, hygiene items and team composition. The fact that one of the scrub nurses ‘mumbles’ these items and writes down the names on the board herself indicates that she is aware of the incomplete performance of the time-out. Nonetheless, she does not communicate about these items with the other team members. The working situation hindered the possibility to immediately ask for further clarification; why did the scrub nurse mumble? A conversation later on, however, focuses on the experienced hierarchical relations. This scrub nurse is finalizing her education, and because of her educational program, she has worked at various surgical departments to get acquainted with the diversity of surgical interventions. The observation note reflects the conversation we had about the performance of the time-out in various contexts. Scrub nurse: “The performance of the time-out differs widely. In some instances, it is just very quick and superficial, while in other cases, it is a rather extended procedure in which all items on the checklist are also written down.” I: “How do these differences occur you think?” Scrub nurse: “I think it has to do with how approachable the doctors are, and whether it’s a ‘real’ team. It has to do with the atmosphere, whether there is a pleasant and open atmosphere. Sometimes, you have the feeling that we are all equal, and then it [the checklist] goes smooth. Especially with the older doctors, you notice that it’s more hierarchical.” This conversation shows how individuals high in the hierarchy play a key role in the emergence of connections. Team members refer to a “pleasant atmosphere” and the existence of “a real team” as requisites for performing the checklist together. The surgeons — who often lead the checklist procedure — are indicated as the actors responsible for the atmosphere in the theatre. If other team 5