Marlot Kuiper

189 Checklist as ‘hub’: On routine interactions These responses comes out of the interrelation of routines in the first place, but they are fuelled by the abstract idea of a routine that differs from the artefact. Although the artefact prescribes that anaesthesiologists have to fulfil these tasks themselves, they might feel that this is not necessary in order to deliver safe care. When routines are conflicting, they work around the formal procedure since they consider it safe. At least the most safe alternative. The situation in which the gynaecologist got sick and could not operate also led to some workarounds. Eventually, the two professionals who were going to operate the patients outsourced the briefing to the gynaecologist in training. Alternatively, they went to inform the patients and prepare the interventions. In these situations it shows how unexpected events make that professionals work around the formal rules as inscribed in the artefact, but try the best they can to deliver safe care. Outsourcing means no strict ‘compliance’, but this might very well be the best solution for the situation at hand. 6.5.3 Work without it The third response was labelled ‘work without it’. With this response professionals did not strive to unite incompatible demands, but they explicitly made a choice. They prioritized one task over the other. This might mean working without the checklist, using it partly, or involving only a few team members. However, it might also mean working with the checklist and thereby casting aside another task. The following observation note zooms in on the interaction of the briefing with the handover routine in the trauma surgery department, as introduced earlier in this chapter. We have to hurry to make it to the patient handover in the trauma surgery department where the status of the patients is discussed with all the trauma surgeons. The handover has already begun, and several clinicians are still walking in and out. We have been at the handover for only five minutes when the trauma surgeon nods at me to leave. We have to go to the surgery department for the morning briefing. In the corridor I bump into the head of department; he argues that the idea of a briefing routine is highly valuable, but other routines have been overlooked. The morning handover has been a firmly established routine in the trauma surgery department, and the head of department underlines the value of discussing all the patients within the subdiscipline. It not only valuable to exchange information about patients 6