Marlot Kuiper

154 Connective Routines participants will note if the performances and the ostensive “model” of the routine align (Pentland & Feldman, 2007). If a misalignment between the abstract idea and performances occur, Howard-Grenville, Rerup, Langley, and Tsoukas (2016) suggest individuals can do two things: they can alter the ostensive to match their actions, or they can change their actions to match the ostensive. Differences in hierarchical positions suggest that while those in high positions can make actions align with their ostensive, those in lower positions are forced to amend their ostensive to actions. Or, as the findings of this study show, lower- ranked professionals not necessarily amend their model of the routine. Rather, they do not speak up but perform actions individually, like the scrub nurse who mumbled and checked items for herself. Strength of connections between people and ‘connective potential’ Besides some shared understandings of the checklist that fuel consistent action patterns – for example the understanding that the checklist is a vehicle to receive accreditation - we have also seen how in specialized surgical teams in Plainsboro the presence of shared ideas lowered the perceived need for ongoing coordination of practices. Individuals in the specialized teams relied on their shared understandings about how to go about the surgery, that they herewith precluded the need to continuously coordinate their actions. Rather than consistently checking for safety items, they assumed to “get there”. Based on previous successful experiences, they might entrust the patient will be fine, also without consistently checking items. Interestingly, these findings contradict with the work of LeBaron, Christianson, Garrett, & Ilan (2016) and Dionysiou & Tsoukas (2013) who illustrated how the presence of shared understandings did not preclude the need for ongoing coordinating during routine performances. LeBaron et al. (2016) showed how ICU physicians engaged in significant ongoing work of coordination during a patient handover routine, while they had firm shared ideas of the routine. The explanation for this difference might lie in the ‘strength’ of connections. The argument that frequency of interaction facilitates role taking and the development of shared understandings (Feldman & Rafaeli, 2002; Reichers, 1987; Weick, 1979) is helpful in understanding that the specialized surgical teams with frequent interactions, rely on firmer shared understandings than the ICU physicians in the case of LeBaron et al. (2016). Frequency of interactions thus presents a continuum on which shared understandings are being developed, in which firmly shared understandings ultimately might undermine the need to coordinate action i.e. consistently use the checklist.