Marlot Kuiper

185 Checklist as ‘hub’: On routine interactions it differently, they had to make something out of it in the most safe and efficient way. Prioritization may come at the cost of the checklist routine, as not everyone participated in the routine, and the time-out was performed in a flexible way. At the same time, the checklist routine still provided guidance. Even in disruptive situations, the checklist provides some stability. Despite ‘flexible’ performances – as also illustrated in the previous chapter – the checklist is nested in existing workflows. The next paragraph explains three strategies that professionals mostly develop to deal with incompatible demands. They can’t be at two places at the same time, patients get anxious, materials might get forgotten. In the interaction of all these processes, how does the checklist work then? 6.5. Dealing with incompatible demands: three strategies As observations proceeded, I faced numerous situations in which the envisioned routine connections led to incompatible demands for participants. Incompatible demands that are entrenched in the surgical process, such as emergencies or managing surgical processes ‘at the same time’, make the performance of the checklist as a hub difficult. Besides, more unexpected events like sick doctors, disrupt the program and pressure prioritization. I further explored how professionals responded to these incompatible demands. From the data I derived three responses that routine participants developed to deal with these conflicting demands: work on it , work around it , and work without it. 6.5.1 Work on it The first response was labelled ‘work on it’. This tag emphasizes that professionals are ‘busy doing things’. In the best way they can, they try to unite incompatible demands. The following note illustrates how one of the anaesthesiologists was confronted with conflicting demands. Because several delays occurred in the process, anaesthesia was demanded at two operating theatres at the same time. The observation note reflects how he goes about managing these demands. 6