Marlot Kuiper

177 Checklist as ‘hub’: On routine interactions surgery and anaesthesia. However, aligning professional practices and creating a ‘hub’ in the form of the checklist, appears a daunting task. The lack of fit of the checklist with existing workflows not only seems to hinder the creation of a connective routine, but the basic irritations tend to reinforce segmentation and thus stimulate the opposite effect. Also at St. Sebastian’s, the programs at the various operating theatres start at 8.00am. Also here, anaesthesiologists are responsible for two of the operating theatres at the same time. The following note represents the start of the day at St. Sebastian’s, shadowing anaesthesiologist dr. Herbers. It is 7.50am when we enter OR4. “We just did the briefing, no particulars” the surgeon says. Although the surgeon did the briefing with the anaesthesiologist in training, dr. Herbers still has some questions regarding the preparation and the process. A couple of minutes later, me move to OR5. Nobody there yet. “Let’s have a coffee then!” the anaesthesiologist says. After we finished our coffee, we get back to OR4. The patient is already on the table. When the surgeon initiates the time-out, all team members surround the surgical table. The surgeon leads the time-out procedure while holding the checklist in his hands. The order of the items differs from the order in the artefact, but all items all covered. Thereafter, we move to OR5 for the time-out. Dr. Herbers knocks on the window of the neighbouring room where the scrub nurses are preparing the equipment. Immediately, everyone stops their activities to participate in the time-out. In this OR, dr. Herbers leads the time-out procedure, that contains of two parts. First, he checks the first items of the checklist with the patient. Next, he instigates a ‘briefing-like’ conversation with the team members to discuss the preparation and instruments. Again, this observation note shows how professionals – in this case anaesthesiologists – cannot be at two operating theatres at the same time. Both operating theatres strive to start at 8.00am, and the anaesthesiologist has to decide where to go first for the briefing. It showed that there are no routines for prioritization. Some anaesthesiologists explained that the medical condition of the patient and the complexity of the intervention determine where they start, 6