Marlot Kuiper

170 Connective Routines performances became evident. Based on the observation data, I first schematized an ideal typical situation in which the checklist does generate connections between different routines (figure 13). Although this visualization is a significant simplification of reality, it does provide insight into both the various practices that construct professional work and the envisioned connections between them. The vertical flow of boxes represents the various activities individuals are engaged in. The horizontal lines in the figure represent the location in the processes where the different phases of the checklist (briefing, time-out, sign-out) have to be performed, and thus connections established. There are a few important observations supplementing this visual. First, professional work is layered since it consists of: (1) individual work practices, such as checking upon patients, (2) professional routines within subdisciplines, such as handovers; and (3) multidisciplinary routines that connect the various routines, such as the time-out in the Surgical Safety Checklist. Importantly, the individuals from different professional disciplines that are involved in the performance of the Surgical Safety Checklist routine, thus all are also involved in multiple different routines within their subdiscipline. The SSC can hence be considered a ‘hub’ in which different disciplines have come together. This involves a significant matter of coordination, fine-tuning and deliberation. Second, the organisation of work processes differs among the professional disciplines: the organisation of surgical care is serial, whereas the organisation of anaesthesia is parallel. Anaesthesiologists have to manage at least two parallel surgical processes in different ORs simultaneously. This is with the exception of the very specialized types of work, in which the anaesthesiologist has full responsibility for just one operating theatre, such as in vascular or cardiothoracic surgery.