Marlot Kuiper

193 Checklist as ‘hub’: On routine interactions The context embeddedness of the checklist also has implications for implementation in terms of ‘transferability’. As I viewed the checklist routine not as isolated, but as a socially embedded construct with internal dynamics, that are in turn affected by the bundles of routines it is part of, I can also conclude that they are therefore not easily transferrable from one context to another (see also Parmigiani & Howard-Grenville 2011). It is not only about the social construct of the checklist, but about the construct of a wide variety of routines, that differs across contexts. In ‘implementing the checklist’ ‘implementers’ should not look for blueprints or general lessons like “A system that holds people accountable for improper behaviour or use of the initiative should be considered” (Russ et al., 2015, p. 89) as they only can get meaning and substance within specific contexts. Secondly, a multitude of routines make the notion of ‘compliance’ problematic. In the theoretical paragraph about routine interactions (3.2.2) I discussed how many studies on the implementation of the Surgical Safety Checklist focused on ‘compliance’ and how these empirical studies were confined to either registration numbers, or isolated observation of the checklist performance. By considering the multiplicity of routines, I have been able to answer questions like: Why wasn’t the anaesthesiologist there? Why did the surgeon already start with the briefing? Questions that would otherwise have remained unanswered. By observing just the performance of the checklist in the operating theatre, and herewith neglecting the interaction with other routines, these instances would have been reported as ‘non-compliant’. The findings of this chapter have shown how for example lacking attendance of professionals, not necessarily results from professional resistance towards the standard, but that this might very well be the result of strategies that professionals develop to cope with interacting and often conflicting demands. In his seminal work, Lipsky (1980) already extensively described how frontline workers developed their own routines and practices to control clients and reduce the consequences of uncertainty within their work environment. The high-paced and complex environment makes it hardly impossible to always neatly follow the standard. So called ‘workarounds’ have been widely identified in recent studies. Studies that focus on coping strategies of professionals, have all underlined the often competing pressures professionals have to deal with in the everyday execution of their work. Hendrikx (2018), Hendrikx & van Gestel (2017) and Van Gestel, Kuiper, & Hendrikx (2019) noted that secondary school teachers work overtime a 6