Marlot Kuiper

144 Connective Routines the checklist to check if I don’t overlook something I think I know.” This conversation lays bare the different ostensive understandings that actants might have about what the routine actually should be. To this surgeon, the essence of a checklist is that you check these items following the checklist, to make sure you don’t forget about or mess up something you think you already know. Using a checklist is therefore ‘professional’. A different abstract pattern is that the checklist is a help to routinize safety checks. After the safety checks have become routine, you don’t need the checklist anymore. Moreover, it’s not very professional to continue using a checklist, this implies that you don’t know what to do. Or as an orthopaedic surgeon put it: “It has to be in your system.” “Routinizing safety checks” or “routinizing the safety checklist” are two very different things however. The second understanding, “it has to be in your system”, aligns with the previous argument about professional judgment. Taking care of patient safety is something professionals always have been doing, they don’t need a checklist for that. Besides, many of them think that it is a sign of professionality if they don’t need a checklist. As a professional you know what to do, and therefore also know how and when to pay attention to patient safety. This also means that they use the checklist – or ‘deal with safety items’ better phrased – in a more flexible and unstructured manner. These two abstract understandings result in different patterns of action. Both involve checking safety items, but only the understanding of a check list fuels action patterns in which professionals consistently involve the artefact. The ‘routinize safety items’ understanding, appears the dominant one, resulting in action patterns that are more ‘loose’. 5.5.2 ‘Ticking off boxes’ On the one hand, there thus is the checking activity with the patient. Action patterns may differ based on individual understandings of the checklist, but overall there is a distinguishable routine in which safety items are checked and confirmed in interaction with the patient. Within the checklist routine, a ‘separate’ and consistent action pattern emerged: registration.