Marlot Kuiper

172 Connective Routines Third, this figure merely represents one series of routines – that is, one surgery in each operating theatre – while the number of operations per theatre can add up to seven or eight a day. Also, the blocks that represent time slots are clearly demarcated, but in reality the length of these blocks is highly unpredictable. The scheduled time for a surgery might be one hour, but because of unexpected events, for example concerning the patient’s condition, this timing might fluctuate. Finally and importantly, this visual does not provide any information about the ostensive dimension of the various routines, and thus the values and norms encompassing these routines. It therefore neglects value judgments and thus pressures for prioritization. All in all, the lines that represent the connections in the ideal type are not that straightforward. In reality, the envisioned connections lead to incompatible demands for professionals, for example because the time blocks might overlap and thereby disturb the emergence of connections. In the remainder of this chapter I will first provide detailed descriptions of everyday situations that steer conflicting demands for professionals. There are what I call ‘standard’ problems, since they seem inherently embedded in the organisation of surgical care, and there are unexpected events that can cause conflicting demands over the course of the day. Paragraph 6.5 then shows how professionals deal with these conflicting demands. 6.3 ‘Standard’ problems First of all, there are ‘standard’ problems. It is important to emphasize that ‘standard’ does not mean ‘simple’. I use the notion of a ‘standard problem’ to illustrate that these types of problems are indisputable, at least, if surgical care is organised in the way it currently is. Standard problems are embedded in the process, they are always there. Such standard problems often require customized solutions and decisions on the spot. In this paragraph I describe two major standard problems. First of all, the chronical lack of time and the irony of planning, in which trauma surgery – in which emergency is the defining principle – serves as a critical case. Naturally, in general surgery there might be emergencies as well (paragraph 6.4.1), but for trauma surgery, emergency is the rule rather than the exception. Secondly, the organisation of the care process and the impossibility of being at two places at the same time.