Marlot Kuiper

159 How standards work out in medical teams: On routine dynamics 5.8 To conclude This chapter focused on the question: “ How do standards work out in medical teams?” Medical teams really work with checklists. Professionals are not only resistant and attempt to restore or maintain the status quo, they actually work with checklists to improve case treatment. Safety checklist can be considered an organised response to safety challenges. Still, frontline professionals are mostly busy with securing the safety of their individual patients, thereby showing ‘modest’ hybridity. There is agreement that checking safety items is crucial part of professional work, and always has been. Importantly, ideas of what the checklist is or how it should be used diverge. For instance, some consider the checklist a tool to memorize safety checks, while others see the checklist as an artefact that should be routinely used. Especially surgeons are more hesitant towards the latter, the idea of a check list , as they often doubt the checklists’ evidence base. Even though other professionals in the team value the checklist for reducing mistakes and enhancing teamwork, these ideas will not automatically translate into the collective understanding. Hierarchy proved important for explaining how (individual) ostensive aspects translate into practice. Those teammembers with high hierarchical positions have the agency to amend performances to their abstract ideas, while those lower in hierarchy are inclined to amend their ostensive aspects, or perform their guiding principle individually. Hence, high- ranked professionals can be identified as frontrunners. If they use the connective potential that is mostly already there, firmer connections can be established. To conclude this chapter and continue to the next; a focus on routine dynamics offered answers to the question how standards work out in medical teams, though these are partial explanations. How standards work can only be fully understood by looking at their interrelation with other routines and artefacts. In other words; surgical care is not only about the checklist. Or to use the phrasing in the anonymous artefact; it is not only about the soup. Surgical teams also have to take care about the lasagne, salads and the drinks. And they have to be served at exact the same time. In the next chapter, I therefore shift the focus from internal routine dynamics, to routine interactions. 5