Marlot Kuiper

149 How standards work out in medical teams: On routine dynamics Inspector: “Do you know that there’s a strand of hair coming down your cap?” I: [blushing] Oh…I’m sorry, I just looked into the mirror fifteen minutes ago and then everything was fine…” Inspector: “I feel more sorry that none of your colleagues addressed this.” After an uncomfortable silence I try to get the conversation back to the checklist. I: “I was just wondering, how should the team ideally perform the checklist?” Inspector: “They must do it and also register it.” I: “Yes, but how should they do it? What would it look like?” Apparently, the question how teams should perform the checklist is a difficult one. This inspector clearly focused on things that are easy to observe and monitor: do individuals know what the atmospheric pressure should be? Do they wear a cap? Do they wear earrings? Do they put on a mask? Do they register procedures? As I am chatting with the scrub nurses afterwards, it shows how this approach causes frustration among teammembers. They are willing to show the registration of the checklist in the computer, but what surgical care is actually about is pushed into the background. Or as the scrub nurse, who clearly was irritated, said: “She doesn’t even wanna know what we are actually doing here!” I felt uncomfortable myself in the conversation with the inspector, as I only had the intention to live up to hygiene protocols. To ‘observe’ if teams registered the performance of a checklist is more easy than to observe how they actually do it. What is important? Where do you pay attention to? In the conversation it showed that the Inspectorate was having a hard time in going about this. Just checking numbers is simple and ‘effective’, but as said, it not necessarily gives a good impression of what actually is going on. The inspector concludes that she doesn’t really care who does the time-out, be it the surgeon, anaesthetist or nurse, as long as it’s been done. This chapter has shown how it actually does matter. In sum, Hospital Boards, Inspectorates, and accreditation organisations concentrate on numbers. They often even equate the registration of procedures 5