Marlot Kuiper

208 Connective Routines because they are easier to observe 22 , typically being written down or embedded in technology (i.e. software, machines) (see also D’Adderio, 2011). The artefactual representations of routines thus can take on different forms, such as printed posters, memory boards or modules in the software system. They can be either materialized (e.g. checklist on paper) or digitalized (e.g. checklist embedded in the software system). For each of the hospitals, I will first give a short and ‘technical’ description of what the artefactual representation of the checklist ‘looks like’. But as I will show, these representations only matter in terms of their (perceived) possibilities for use. Therefore, the subsequent paragraphs will explicitly analyse how these representations actually ‘model’ the routine in practice by looking at their affordances and uses in context. Plainsboro In Plainsboro Teaching Hospital, three artefacts have been introduced that represent the Surgical Safety Checklist: (1) a digitalized version that is embedded in the software system, (2) posters that are put up in the operating theatres, and (3) tabloid-sized whiteboards that are to be filled out during the procedure. Firstly, an important artefactual representation of the checklist is a digital one. Digitalization is, in a broader sense, one of the main focus areas for Plainsboro. To make information more accessible and reduce registration burdens, all the information is synchronized in the Electronic Care Information System (EZIS). This for example means that measurements from applications at the patients’ bed such as the heart rate metre are automatically uploaded in the system. This also implies that the registration of the checklist is to be done directly through this electronic system, without interference of paper. Before starting the surgical procedure, members of the surgical team have to fill out the checks as indicated in the digitalized checklist. Secondly, there are material representations of the checklist in the form of posters that are put up in the theatres. The posters visualize all the items on the checklist as a memory support and require no further action. Thirdly, there are tabloid-sized whiteboards that need to be filled out with a marker while checking. Important to note is that these whiteboards are different from the bigger whiteboard that is put up at the wall of the theatre, on which 22 See also chapter 4 for these methodological accounts.