Marlot Kuiper

138 Connective Routines In this situation, the surgeon decides on the spot what he deems necessary. Naturally, operations require conscientious preparation. Mostly the day before, surgeons and anaesthesiologists both prepare the cases, separate from each other. The surgeon prepares the intervention by deciding how to go about it and listing the equipment that is needed for the surgery. The anaesthesiologist decides what kind of anaesthesia is needed for the intervention, whether there are special conditions to take care of, and how the patient can be best positioned for the surgeon to do his or her job. In this specific case of orthopaedic surgery, the surgeon relies on his own preparation; he concludes that the patients are “all healthy people” and decides to not further consult the anaesthesiologist in the briefing. So although professionals do attach value to ‘evidence based practices’ and want to know ‘what works’, such evidence gathered in checklists is not used as a blueprint. The professional decides on the spot how to use ‘the evidence’, which means that checklists are often used as ‘assistance’, but only in case that assistance is deemed needed. In case of seven ‘standard’ knee scopes on seven ‘healthy people’ the checklist is used in a very flexible way. Linking to this idea of professional judgment – that fosters the ostensive understanding of the checklist being merely a ‘help’ – is the argument made by multiple respondents that the “checklist is nothing new really.” Both surgeons and anaesthesiologists claim that patient safety is, and always has been, at the centre of their attention. A gynaecologist in Plainsboro stated: “We’ve always done it like this, I don’t need a checklist to work safe.” An orthopaedic surgeon said: “We’ve been checking for safety items long before there ever was a checklist”. This is where a difference in abstract understandings between the more senior and thus experienced doctors, and the more junior professionals manifests itself. Senior doctors in particular, might feel challenged by the introduction of a formal standard. They have developed routines for patient safety, but with the introduction of a new formal standard it gives them the impression that what they always had been doing “wasn’t good enough”. However, professionals themselves often feel that they don’t need a formalised standard to work safe. For the novices on the other hand, there is no ‘then versus now’ situation. They have entered the field in a time where the checklist had already made its way into surgery. They often claim that working with checklists is normal to them, since they learned about checklists in med school. To them, working with a checklist