Marlot Kuiper

134 Connective Routines members - especially scrub nurses - feel free to speak out, they are more inclined to participate in the team discussion and interrupt when necessary. However, if the surgeon explicitly presents him or herself as leader of the team and others do not feel that they are “all equal,” it becomes more difficult to cross these hierarchical borders. In these situations, there is attention for the checklist, for example by the scrub nurse who mumbles and completes the items by herself, but not in a connective matter. The checklist routine therefore is an important activity in which actors can construct and strengthen their identity. As surgeons often lead the checklist routine, they are the actants that can break through hierarchy patterns and construct more connective patterns. Paradoxically enough, at the same time the performance of the checklist creates important opportunities to further strengthen their hierarchical position. As surgeons mostly lead the routine, they are literally at the centre of attention. The surgeon puts on a show, in which the other members of the team have to reply and confirm the items. The actant leading the routine, determines the script of routine, the timing, the order of items and the involvement of other actors. This construction of professional roles and hierarchical relations is not limited to the performance the checklist. This process also surfaces in other routines, as I found out. At the first exploratory observation day, I was going to shadow the gate-keeper, to get acquainted with the surgical domain and the ways of working. Before we enter the operating theatre he warns me: “Make sure that you introduce yourself to the team members, especially to the surgeon, that’s very important.” I’m being told that this is a very important unspoken rule of propriety. However, living up to this rule appears a bit more complicated than it sounds. Introducing yourself is something that has to happen ‘on the fly’. Most of the time, when entering the operating theatre the surgical team is already preparing the surgery. As a new ‘teammember’ you thus have to interrupt them while doing their job. Short and even irritated responses were no exception. Moreover, it sometimes appeared to me that people were not really listening since they did not remember my name, and even the fact that I was introducing myself as ‘research assistant’ — a very rare ‘role’ in the theatre – often did not lead to any further questions. In short, you always feel uncomfortable since on the one hand it’s a ‘no go’ to not introduce yourself, while at the same time doing so often doesn’t seem much appreciated.