Marlot Kuiper

187 Checklist as ‘hub’: On routine interactions argued that they were already used to performing safety checks before surgery, but with the formal checklist that requires all team members to be present, the process became more complicated and was often disturbed. In other words: “It distracts me from what I’m doing.” From a surgery perspective, the abstract idea of the checklist routine becomes a distraction rather than a valuable tool. This ostensive idea did not come about in isolation, however; it was fuelled by the interrelation with other routines where a misfit occurred. Because the different routines do not connect, the checklist not only seems to fall far short of expectations, but also seems to reinforce routines within the subdisciplines – including senses of ‘us’ and ‘them’ – which makes the establishment of connections all the more difficult. This situation resembles the situation with the very anxious patient with the schizophrenic affective disorder. The anaesthesiologist did everything within his power to ‘make it work’, but tensions between the anaesthesiologist and surgeon proved unavoidable. 6.5.2 Work around it The second response reflects strategies used by professionals to get to the best result by adjustment; they work around (Morath & Turnbull, 2005) the formal procedures. So, rather than doing the best they can to make it work anyway, professionals fashion a solution to an unexpected problem or situation. This response has been identified in medical settings in earlier research (e.g. Koppel et al., 2008; see Debono, 2013 and Halbesleben et al., 2008 for overviews). Workarounds occurred in different ways. For example, they might involve completing and registering tasks at different moments than prescribed – surgeons who register the completion of the time- out checklist before actually performing the checklist so they can move on more smoothly (see also chapter 5), or who perform the sign-out checklist that entails recording post-operative agreements when these agreements are still to be made. Workarounds might also involve outsourcing operational tasks to someone else. The following observation note illustrates how an anaesthesiologists outsourced his tasks to a nurse anaesthetist who was lower in the hierarchy to deal with incompatible demands. The anaesthesiologist has been called because the patient is ready for the time-out checklist. I follow the anaesthesiologist to the operating theatre, but when we get there the surgeon is not present. The anaesthesiologist starts wandering around the surgery department to see if he can find 6