Marlot Kuiper

142 Connective Routines should be done, this might lead to a tension with consistently checking for safety items as people trust that they “will get there”, because they always do. At the same time, communication and collaboration are no ‘automatic’ outcome of the checklist. Rather, connections are a requisite to make standards work in practice. Actants in a high position play a key role in maintaining or changing the status quo. 5.5 Maintaining accreditation Although taking care of patient safety is something that professionals consider something they have been doing for years already, there is – particularly from an organisational perspective – a clear impetus to make this explicit by implementing a safety checklist: Accreditation. Hospitals can receive an accreditation from an independent, external organisation that evaluates their performance. The accreditation organisation assesses if the hospital delivers high quality and safe service to its patients, based on a wide array of performance indicators, such as adherence to checklists. With accreditation, hospitals can thus show ‘the outer world’ that they have things properly organised; that they have implemented protocols for safe care, and herewith they can gain legitimacy. With accreditation, registration becomes particularly evident. After all, checking items becomes not only a matter of checking as such , but also a matter of registration. In practice, two separate action patterns emerge: (1) checking and (2) ticking off the boxes. 5.5.1 Checking It is 7.30am when I enter the surgery department at St. Sebastian’s. The nurses at the secretariat warmly greet me when they hand me my ‘guest’ pass, they already know me by name. “So you’re going with doctor Hood 4 today”, she says. “He’s with the E.N.T. today. That’s quite machinery work, you’ll see.” That was no exaggeration. The E.N.T. specialist was going to do a ‘street’ of throat tonsil removals that day, and dr. Hood was responsible for anaesthesia. Removal of the tonsils is an intervention that is mostly performed on very young children. The intervention as such is not that risky, however, it is of crucial importance that when the patients get out of anaesthesia, they are in an up-right position so they will not drown in their own blood. 4 All names in this dissertation are fictive