Marlot Kuiper

150 Connective Routines with their actual performance. For work at the frontline, this implies that actually two separate action patterns within the same routine emerge. The first one is the actual checking, that is mostly, fuelled by professional judgment, amended to specific situations and needs. There are different abstract patterns (routinizing the checklist/routinizing safety checks) that enable different activity patterns. The second one is the registration, that is consistently done. In registration professionals demonstrate a less pro-active attitude, they want no trouble. 5.6 Main findings and reflections In this chapter, I have shown how medical professionals really use medical checklists as artefacts, although I sketched a nuanced picture. In many ways they are critical of new standards and they ‘tick the boxes’ while working with them, but they also really use standards to improve case treatment. In this paragraph I discuss the main findings of this chapter to analyse standards as dynamic systems of ostensive and performative dimensions. 5.6.1 “The checklist” does not exist From the findings of this chapter, we can conclude that there’s no such thing as ‘the checklist’, in terms of how professionals conceive the checklist and how they refer to it. It is widely known that images of what the checklist is or should be affect how they are actually used in practice. Feldman and Pentland (2003, p. 101) identified the ostensive dimension of routines as “the abstract, generalized idea, or the routine in principle.” Routine participants use the ostensive aspect to guide their actions, to account for what they are doing, and refer to patterns of activity that would otherwise be incomprehensible. Feldman and Pentland (2003, 2005) already underscored that it is actually ostensive aspects in the plural, since individuals can hold different understandings, for example based on their perspective. The findings of this study confirm and extends this view by showing that the “the routine in principle” could be conceived as an abstract superset of several subsets presenting the individual understandings of the routine. The collective understanding of the routine is thus layered and built out of multiple subsets (figure 10,11). The figures represent a simplified picture of ostensive subsets, taking into account three individual, subjective understandings. First, figure 10 shows the interrelation of ostensive perspectives from different professional backgrounds, i.e. an anaesthesiologist, a surgeon and a scrub nurse. Some of their