Marlot Kuiper

197 Checklist as ‘hub’: On routine interactions Figure 14: A model for routine interactions in professional contexts 6.8 To conclude This chapter focused on the question: “How do (new) checklist routines relate to existing routines?” A checklist in professional work does not stand on its own. I found the interdependence with conflicting routines to be an explanation for variability in routine performances. The routine connections as intended by the checklist are often not that straightforward and may even lead to incompatible demands for professionals; they have to be at two spots at the same time, deal with delays in the program, and frightened, demanding patients. Rather than standardized responses, these incompatible demands require responsiveness. I derived three responses that professionals have developed to deal with incompatible demands: work on it, work around it, and work without it. These responses often entail ‘on the spot’ decisions; there are no formal routines for prioritization, but ‘games’ of prioritization and constructing emergencies. Further, the findings, show how routine dynamics can be altered through the interaction of routines. For example, because of a conflict between existing routines and the envisioned checklist routine, ostensive aspects of the routine might change from a ‘helpful tool’ into ‘a distraction’ and thereby affect performances. How professionals value the checklist routine is thus not so much about the checklist itself, but about its (mis)fit with existing routines. 6