Marlot Kuiper

153 How standards work out in medical teams: On routine dynamics envisioned routine, routine participants rely on each other’s information and the anaesthesiologist confirms items as named by the surgeon. However, based on his professional judgment, the surgeon decided not to consult the anaesthesiologist and thus not align practices based on role taking. Moreover, surgeons often depart from the idea that the patient is “their patient” which centralizes their own role, and precludes taking on others’ roles. In such situations, individual understandings also enable individual action patterns. Hierarchical positions in the team The presence of such individual understandings resulting in individual patterns of action, does not imply that individual understandings cannot ultimately lead to collective patterns of action. In understanding how individual understandings ultimately become shared while others are not, hierarchical positions are relevant to consider. An individual understanding can still find its way in the collective understanding, even though it might not be shared from the beginning. In the example, the anaesthesiologist understands the checklist as something that will improve teamwork. Though, this idea was not shared with for example the surgeon. But, if the anaesthesiologist – who’s high-ranked position is acknowledged by the team members - starts to perform actions that are guided by this abstract pattern (introducing himself, writing names and functions on the board, calling people by their names, asking for weekend plans) this might instigate a change in other individual abstract patterns (the checklist improves teamwork), and thus ultimately in the collective understanding. It is important to note that the hierarchical position of the anaesthesiologist provides opportunities to amend abstract patterns. As Cast (2003, p. 188) put it, some powerful individual individuals will more than others be able “to alter the situation so that meanings in the situation are consistent with their own definition of the situation.” This helps explaining why the scrub nurse, who holds the same understanding regarding teamwork (figure 11), but has a considerably lower position in the hierarchy, mumbled and did not change action in interaction. The observed ‘uneasiness’ with speaking up, might indicate hierarchical relations in the team. During the informal conversations, participants showed well aware of such relations, by referring to the high ranked or referring to their experiences of an ‘equal’ team. The different hierarchical positions thus also imply differences in professional agency. Hence, insights from the Sociology of Professions are helpful in understanding how ostensive aspects are (not) amended. When performing a routine, 5