Marlot Kuiper

148 Connective Routines A site visit of the Health Care Inspectorate illustrates how tensions arise between the checking routine with the patient and the registration routine. It is 7.45am when I lean with my back against the rear wall of the meeting room. The morning handover of vascular surgery is about to start. In the handover, interesting cases from the night shift are discussed and the patients that will be operated throughout the day are briefly discussed with the whole team. Mostly, this means that the surgeon explains what he is going to do. Before we get started, there is one final message: “We just heard that an inspector will be joining us today” The Health Care Inspectorate makes regular visits to all hospitals. Some of these visits are announced, others – like this visit – are not. The idea behind these site visits is that the inspector is able to observe how surgical teams usually work, that is: what their work routines look like. The site visit has been announced just before the morning briefing. Immediately, all teammembers are made aware of this. The team members are very aware of the fact that they ‘will be watched’ today, “just make sure we live up to all protocols” the surgeon closes the meeting. It is 10.45am, the team is operating the third patient of the day. So far, all parts of the checklist have been consistently performed for each patient; the surgeon holding the artefact, reads out the items that are confirmed by the patient and the other team members. It’s a tense atmosphere. The inspector has positioned herself at the back of the operating theatre. Halfway the operation she walks towards one of the scrub nurses who is responsible for the instruments. I can catch up their conversation: Inspector: “Can you show me the time-out?” Scrub nurse: “What do you mean exactly?” Inspector: “Well in EZIS [the software system] of course!” When the inspector finishes the conversation she walks towards me. Inspector: “Can you tell me what the atmospheric pressure in the operating theatre should be?” I excuse myself by explaining that I am just an observing research assistant. The conversation then evolves into a different direction.