Marlot Kuiper

143 How standards work out in medical teams: On routine dynamics That day, my pedometer showed some impressive results. As it was mostly children we were operating, the anaesthetist was picking up the patients himself at the holding. From there, we took them to the operating theatre to make them feel a little more at ease. Directly after the intervention, we delivered them at the recovery and assisted them in awaking from a light anaesthesia. After that, we rushed to the holding to pick up the next patient, and so on. So, when the surgeon was performing the sign-out with the operation assistants for example, most of the time we were already on the move. After a short break however, everyone was back in the theatre and I could observe the E.N.T. specialist performing the time-out while holding the checklist in his hands, and reading the items that were listed out loud. This was something different than most of what I had seen before; surgical teams indeed performing a time-out, checking items, but not explicitly using the checklist while doing so. At the end of the day I started a conversation with the E.N.T. specialist to gain an understanding of why he actually used the checklist so explicitly. I: “What does this checklist mean for how you do your work?” E.N.T. specialist: “This is really routine work actually. Removing the tonsils is not that complicated, you just know what to do, where to take care of, and they are all healthy young children.” I: “So what does the checklist then?” E.N.T. specialist: “I think it is exactly these types of surgery where you need a checklist for. It goes fast, many different patients. You see, when you have to do something that is very complicated, you are aware of that and make sure that you have everything covered. When it is like this, something might slip through, so I always make sure I have the right patient in front of me.” I: “Many people told me that that’s something they always have been doing, checking whether it indeed is the right patient, or the right surgical site. That they don’t need a checklist for that..” E.N.T. specialist: Well, that’s exactly the point. I know [emphasis added] these things too. But that’s the danger. I use 5