Marlot Kuiper

190 Connective Routines and ideas to go about surgeries, it also strengthens professional bonds within the discipline. The introduction of the briefing, however, interfered with this routine since it requires surgeons to be at the operating theatre at 8am for the briefing. In order to manage this, they skip the handover. “So they are going to a briefing to discuss the patients, but they haven’t even properly discussed these patients within their own department”, he concludes. The handover, a longstanding routine within the trauma surgery department, had been put into second place by the multidisciplinary briefing. Professionals cannot fulfil these two tasks, and they prioritize the new routine. This made me wonder why they choose the new routine over the longstanding tradition. Apparently, from a clinicians’ perspective the ostensive dimension of the routine was that this briefing was ‘important’. The briefing had been made into a formal routine and was reflected in several artefacts. In addition, surgeons argued that they were judged on their performance of the briefing – or rather, on the registration of the briefing. The patient handover in the trauma surgery department, although firmly institutionalized, was an informal routine. It was a longstanding tradition but was not backed by artefacts per se, and clinicians were not directly judged on it. The briefing, as part of the new checklist routine had been made more prominent, backgrounding the institutionalized handover. Despite the head of the surgery department valued the new routine, he shows considerable dissatisfaction with the replacement of the routine that structure work in his sub department for a long time. 6.6 Main findings and reflections In this chapter, I showed how the interaction with existing work routines greatly influences the checklist routine. In studies on organisational routines, their interrelatedness has been widely acknowledged (Feldman et al., 2016; Parmigiani & Howard-Grenville, 2011; Salvato & Rerup, 2011) but empirical insights into the mechanisms underpinning routine interactions, are little. This chapter contributes to our knowledge by showing that in the interaction of routines conflicting demands may arise, and how consequently ostensive ideas