Marlot Kuiper

139 How standards work out in medical teams: On routine dynamics is therefore not so much a change in routines, but rather performing a routine that is just part of their work. In sum, reducing medical mistakes is for most professionals the checklists’ raison d’être. They attach great value to an evidence base, and because the evidence base of the Surgical Safety Checklist is often considered ‘too thin’, professionals are not unanimously convinced of its effects on outcomes. They therefore flexibly use the checklist in their activity patterns. Besides, doctors themselves decide how they use scientific evidence in their decision making. Different roles have different perspectives though; individuals who have been involved in introducing the checklist in the field are convinced that the checklist works. They also have a broader understanding of what the checklist is and can do. 5.3.3 Team compositions Althoughmost surgeries are performed in ‘variable’ teams and an explicit purpose of the checklist was to create firm connections among team members, there are a few subspecialties where teams work together in more stable compositions. Subspecialties such as cardiothoracic surgery and vascular surgery are forms of very specialized work that require more stable teams. Anaesthetists that work in cardiothoracic surgery, for example, mainly work in these specialized areas. Therefore, stable teams emerge in which surgeons, anaesthetists, nurse anaesthetists, scrub nurses, and clinical cardiac perfusionists frequently work together. Because of these frequent encounters, these teams have the possibility to create shared understandings about what has to be done and what is appropriate. I conducted observations at both the departments of vascular and cardiothoracic surgery to see how these specialized teams work with the SSC. The observation day at the cardiothoracic surgery department starts at 8.00am in the operating theatre. The team immediately starts with the time-out — the second part of the checklist. Since all teammembers only have responsibility for operations in this OR today, everyone is present in time 2 . The cardiothoracic surgeon starts the time-out and checks the patient’s identity, allergies, and prosthetic devices, and he performs the procedure entirely from memory. 2 In specialized areas such as cardiothoracic surgery or vascular surgery, the anaesthesiologist is responsible for just that operating theatre, and is therefore present all the time. In general surgery, each anaesthesiologist is responsible for two operating theatres simultaneously. In Chapter 6 I show how professionals try to manage these different work flows. 5