Marlot Kuiper

191 Checklist as ‘hub’: On routine interactions about registration can foreground some routines at the expense of others. In this paragraph I discuss the main findings of this chapter to analyse the surgical checklist as hub, interacting with multiple professional routines. 6.6.1 Practicalities cause segmentation instead of collaboration As we learned in the previous chapters, one of the main aims of the checklist, at least from an ‘organisational’ or, ‘implementers’ perspective if you wish, was to improve collaboration. Chapter 5 showed a variety of abstract aspects regarding collaboration at the frontline. Some professionals indeed saw and used the ‘connective potential’ of the checklist, where others were more hesitant or even negative. In this chapter, I showed how in the interaction of routines, there are mechanisms that fuel the negative abstract patterns regarding collaboration. ‘Basic’ practicalities like delays make the hub function of the checklist particularly difficult. This generates basic irritations, simply because people have to wait for one another. As touched upon in the previous chapter, professionals often lack taking the role of others (Mead, 1934) so they can anticipate their activities on those of the other team members. Surgeons who get annoyed for example, because they do not have an overview of the efforts of the anaesthesiologist in the other processes he/she is also involved. Still, these irritations caused by practical matters, ultimately reinforce more fundamental notions like ‘us’ and ‘them’. In the theoretical chapter of this dissertation, I explained how professional segmentation is an important aspect of ‘becoming a professional’ (see paragraph 2.2.2.). Because of firm institutionalization processes in which novices learn the appropriate behaviours, also in relation to others, it is hard to overcome these boundaries (Baker et al., 2011; Cameron, 2011; Freidson, 1994; Hall, 2005; Lingard et al., 2004). And, as the findings suggest, even more when practicalities tend to reinforce segmentation. In sum, in these instances, the checklist seems to instigate irritations that ultimately reinforce ideas of ‘us’ and ‘them’. In Sociology of Professions literature, there often is an emphasis on professionals’ fundamental resistance towards collaboration, as they have predominantly been trained within the borders of their professional segments (Lingard et al., 2004; Abbott, 1988). A focus on routine interactions provides a more nuanced picture. There was not so much fundamental resistance to the new standard at first sight, a lack of ‘fit’ of the checklist routine with the already existing work routines however, resulted in more negative ostensive attitudes. 6