Marlot Kuiper

137 How standards work out in medical teams: On routine dynamics well.” In doing so, providing information and “giving the right example” were at the forefront. Whereas for most of the professionals who work with the checklist in daily practice, the checklist is just there to affect outcomes; to “prevent mistakes.” Preventing mistakes as an abstract pattern of the checklist routine also raised some tension, as according to several respondents this is an “illusion.” Naturally, there’s something to be done about surgical mistakes, is the dominant conviction. However, the tendency to standardize professional work receives some firm criticism. “We’re taking it really, really far”, a gynaecologist working in Plainsboro told me. Especially surgeons felt that what they are doing is “heavily scrutinized.” According to the trauma surgeon I shadowed in Plainsboro: “We should also accept that making mistakes is human. We have protocols and checklists, but you cannot cover everything in checklists and protocols.” The view of his colleague from orthopaedic surgery at St. Sebastian’s perfectly aligned: “Where people work, mistakes are being made, and always will be made.” 5.4.2 Professional judgment; the doctor knows best Paradoxically enough, as the evidence base of an intervention appears crucial in the decision making – “does it work?” - doctors ‘know best’ and should always have the final say. The following observation note illustrates the start of the day in the operating theatre in St. Sebastian’s hospital where the surgeon is about to perform seven orthopaedic knee arthroscopies throughout the day. Briefing At 8.00am the day starts with the morning briefing. The patients to be operated are discussed ‘altogether’. In an informal way, the surgeon informs the other teammembers that they are “all healthy people”. “Nothing special really.” There are no special conditions mentioned the surgical team should take care of. After this concise briefing, in which only the orthopaedic surgeon speaks, he leaves to scrub in. Time-out After a couple of minutes, the surgeon has returned to the theatre and the first patient is already on the table. With enthusiasm, he greets the first patient and assures everything will be fine. Together with the patient, he checks the identity, surgical side and site, and allergies and then gives green light to start anaesthesia. 5