Marlot Kuiper

195 Checklist as ‘hub’: On routine interactions Ultimately, these on the spot decisions unfold into three coping strategies: work on it, work around it, and work without it. Conflicting routine demands make that professionals have to set priorities. Throughout the chapter, lack of time appeared a complicating factor in accomplishing work in the surgery department. Consequently, doing a job timely is considered a valuable trait; professionals have to do the job well, and they have to do it quick. With a chronical lack of time also arises the matter of prioritization, that seems to unfold through a ‘game’. Getting an emergency label implies getting priority, and as for surgeons completing their schedule is of great importance, ‘emergency construction’ appears at different points throughout the process. For example, the start of the program at 8.00am already is where conflicting routines present to anaesthesiologists; they simply can’t be at two spots at the same time. In this sense, emergency construction seems a matter of “who shouts the loudest”, the surgeon who is most convincing will get prioritized. The complexity of the first case is often raised as negotiation trait. Emergency construction is also done to prioritize patients. If a patient gets a ‘emergency A’ label, it will be prioritized over an emergency B or C. This also implies that surgeons with B and C patients are put on hold. There are objective features to determine the level of emergency such as X-ray or blood test results. Still, the combination of such ‘objective’ features makes the construction of emergency subjective. Medical doctors have been portrayed as agents of control (Conrad, 1992; Fox, 1992; Freidson, 1988). They exercise control over the construction of an emergency, by debating on the state of emergency (“my patient is in a more critical condition than yours”) and consequently, who gets surgery first. Besides prioritization that unfolds through the construction of emergencies, conflicting routines steer the (re)negotiating of responsibilities. In the theoretical chapter, I identified the surgical checklist as a ‘static sequential’ in which a designated actor reads out the items on the checklist, and each responsible party verifies completion of this specific task. The results of this chapter show how this matter of responsibility becomes complicated. Conflicting routine demands make that actors with a formal responsibility (for instance, an anaesthesiologist supervising a resident) outsource their activities to actors they entrust, but who do not have a formal responsibility. 6