Marlot Kuiper

183 Checklist as ‘hub’: On routine interactions loss. A conversation unfolds about who should have done this. But still, it hasn’t been done, so there is no blood. It is not clear if the blood issue has come about during the briefing. The surgeon noted that there were “no particulars”, but dr. Herbers wasn’t there. The scrub nurse grabs up the phone to order blood. She gets put through several times, and after a couple of minutes she confirms that the blood is on its way. One of the other scrub nurses leaves the theatre to pick up the emergency delivery at another location in the hospital. After 12 minutes, she returns with the blood and I follow dr. Herbers to the holding to pick up the patient. There had been a morning briefing without the anaesthesiologist present, but the surgeon later on mentioned “no particulars” and attention had not been drawn to the special blood type of the patient. Before the particular intervention is about to start, the anaesthesiologist asks: “has blood been ordered?” This indicates that he has this information on his preparation sheet, and the issue might have been addressed at the morning briefing. Plenty of time would have been saved if this, which indeed is the exact purpose of the briefing, would have been the case. Nevertheless, the blood was not ordered so the team had to act on the spot to create the best possible solution. So, where the surgeon at the start of the day thought to save time by starting off with the briefing while not all the responsible team members were there yet, it got back to him like a boomerang when it showed that things were not sufficiently covered. 6.4.3 Doctors get sick too At a cold day in early January, I had an appointment in Plainsboro with gynaecologist dr. Nieman. As with any respondent who did consent with shadowing, I’ve had an introductory conversation with dr. Nieman before the actual observation 20 . As agreed, I go to the secretariat in the gynaecology staff corridor and introduce myself to the secretary. She replies: “Blimey! Dr. Nieman just called in sick. He will not come into the hospital to operate today.” This means that other operators are taking over 20 For more reflections about the conversations I conducted before commencing into the obser - vations I refer to chapter 4 6