Marlot Kuiper

141 How standards work out in medical teams: On routine dynamics — prompted that items were not explicitly checked. Strong connections made teammembers entrust one another and therefore undermined their felt need to consistently check items, as they rely on many successful team experiences (“We know what we’re doing”) that the patient will be fine. St. Sebastian’s surgery department is considerably smaller than Plainboro’s surgery department 3 . It shows that practices in St. Sebastian’s are kind of ‘in- between’ what’s happening in Plainsboro’s general surgery department and the very specialized subfields. In St. Sebastian’s people actually do know each other by name, they regularly greet each other, and they notice when someone’s returned from a holiday (“Good to see you here again Fred, you had a good time?!”) At the same time, ‘knowing each other’ not generally led to an erosion of the checking activity. Whereas in the specialized areas in Plainsboro there was considerable trust among routine participants, and therefore less systematic checking in interaction with the whole team, in St. Sebastian’s actants are inclined to ‘check’ more often (see also paragraph 4.5.1. in this chapter about understandings of what the checking routine actually should be ). As both hospitals are situated in the same educational region, there are situations in which doctors in training spend part of their training in both hospitals. Therefore it happened that I encountered one of the anaesthesiologists in training who I met in Plainsboro, a couple of months later in St. Sebastian’s. During a conversation in the staff room we discuss her experiences in both the general surgery department in Plainsboro, and the surgery department in St. Sebastian’s. Her expressions very much align with what the operating assistant had told me about a ‘pleasant atmosphere’; If people know each other – which is a deeper connection than just knowing names – as is the case in St. Sebastian’s, it gives the feeling of an “equal” team and you more easily speak out and perform the checklist together. In Plainsboro, at your first you’re more busy with ‘getting to know people’ and getting to know ‘how things are done’, before you even think of speaking out about the checklist. In sum, the checklist envisions connections among team members. In many instances however, such connections are already there. People work together in a pleasant atmosphere and pay attention to patient safety. Notably, when actants have developed firm working routines and shared understandings about what 3 Plainsboro teaching hospital’s surgery department consists of 23 operating theatres, and an additional 14 theatres for outpatient interventions. St. Sebastian’s hospital’s surgery department consists of 10 operating theatres. 5