Marlot Kuiper

176 Connective Routines on the other hand, are responsible for at least two of these operating theatres at the same time, which not only means that they have to monitor two patients at the same time, but also that they have to attend two briefings and time outs “at the same time.” The organisation of the care process thus produces a ‘standard’ problem; The surgeries are all planned to start at 8.00am, but anaesthesiologists cannot split into two to attend both briefings simultaneously. The introductory note of this chapter illustrated how the anaesthesiologist prioritized the briefing and time- out in the OR where a more complex intervention was about to start, so the surgeon in the other theatre already got going. The final sections of this chapter explain the different responses to conflicting demands and their considerations for these responses. First, I show how the checklist can also work to produce ‘basic irritations’, simply because people have to wait for one another. The following observation note reflects the start of the third operation of the day, shadowing an anaesthesiologist at Plainsboro. Time-out: Surgeon: “People, can we please first do the time-out? Where is everybody? I have a full schedule today!” Resident in anaesthesia: [Walks towards the neighbouring room where the operation is being prepared to get the other team members] Surgeon: “Okay, is everybody there? Thank you.” [Does the time-out and then leaves the operating room.] The anaesthesiologist starts to administer drugs for general anaesthesia. When the patient is asleep, about ten minutes pass by. Anaesthesiologist: [annoyed] “Who is waiting for who now?! She could have started surgery ten minutes ago. She was pressing to do the time-out and look what happens now; we don’t even know where she is!” This situation reflects the importance of the embeddedness of the new artefact within existing practices. The organisation of the care process makes it difficult to create a new connective routine within this high-paced, demanding environment. One of the (organisational) purposes of the checklist was to improve collaboration, to better connect the different professional segments like