Marlot Kuiper

207 The introduction note of this chapter already reveals how artefacts afford and constrain certain actions. The representation of the checklist on a piece of paper for example, can be taken close to the patient and throughout the hospital, but at the same time paper gets easily damaged and dirty, and it has to be stored somewhere. The design and transportability of an artefact matter for routine performances, I will show in this chapter. This final empirical chapter is structured as follows. This chapter starts, not so much with a description of ‘artefacts’ that are used in hospitals, but of what I call the artefactual arrangements in both hospitals. Informed by affordance theory, I develop a framework to study how artefacts affect routines, by distinguishing between three dimensions of artefactual arrangements that guide and constrain artefact use: material, spatial, and temporal dimensions. As discussed in chapter three in which I developed a research perspective, the focus on affordances flows from the idea that artefacts are neither ‘things’ that determine human behaviour (deterministic view), nor are they things that are what their users make of them (social-constructivist view), but artefacts do set limits on what is possible to do with, around or via the artefact (Hutchby, 2001). In this chapter, I empirically trace the (variety of) responses to (a variety of) artefact’s affordances. I will show how artefactual arrangements work in professional practice. The findings show that focused attention, clear responsibilities, and collaborative action are anything but automatic outcomes of checklists. In the discussion section of this chapter, I will explain why creating workable artefacts is a continuous struggle. 7.2 From artefact to artefactual arrangement In this chapter, I start from artefacts that directly intend to steer behaviour. These artefacts are often referred to as ‘artefactual representations’ or ‘rule- embedded artefacts’. In this study, these are versions of the Surgical Safety Checklist, that function as a ‘model’ for the actual routine (Pentland & Feldman, 2008; D’Adderio, 2011). Different than the previous chapters, this chapter thus departs from a clear distinction between the research sites, as the artefactual representations can, in contradiction to the ostensive and performative patterns that became visible throughout the research process, more clearly be disentangled by the researcher at forehand and at the research sites. This is 7