Marlot Kuiper

135 How standards work out in medical teams: On routine dynamics The ‘introduction routine’ at the start of the day in the operating theatre is an institutionalized one, and professionals point out its importance. Nonetheless, this routine does not seem to reach a deeper level of ‘connections’ than just exchanging names and roles. The checklist envisions, at least from an organisational ostensive perspective, the creation of connections, by prescribing that teammembers should introduce themselves to one another. The introduction routine that already had ‘been there’ for a long time however, has not been replaced by the checklist routine. In sum, professionals often do not think that the introduction as scripted in the checklist adds value to the quality of the surgery as such. Besides, there already is an ‘introduction routine’ though not fuelling deeper connections than exchanging names. Possibilities for change lie in actants that are ‘frontrunners’ and align their performances with ostensive patterns in which they indeed see the checklist as a means to strengthen connections. 5.4. Reducing medical mistakes Checking is – what’s in a name – at the core of the check list. Rather than relying on the memory of individuals in the team, the idea behind systematically checking safety items is that it would decrease medical mistakes. It turns out however, that those who are working with the checklist are not unanimously convinced that this rationale is correct; do checklists indeed reduce medical mistakes? 5.4.1 The discourse of Evidence Based Practice At one of the observation days in St. Sebastian’s I am in the staff room with the anaesthesiologist I am shadowing that day. Anaesthesiology particularly involves a lot of waiting, so anaesthesiologists spend a lot of time in the staff room, replying to e-mails, drinking coffee and chatting. Another anaesthesiologist picks up the conversation we are having about my research. He engages in the conversation by stating: “You should research if the amount of left/right-mix-ups indeed decreases.” This quote echoes the ‘evidence based discourse’ that shows prominent in this domain. The same narrative is quite dominant in Plainsboro as well, where one of the surgeons even states that “Evidence Based Practice is the only valid underpinning of professional practice.” When talking to professionals about my research in both Plainsboro and St. Sebastian’s, most of the time they found the way I was conducting my research particularly ‘odd’ – observing what 5