Marlot Kuiper

213 sake of transparency and not patient care. These ideas are further exacerbated by the design of the system, as EZIS is not considered a clinical system. At the observation day with trauma surgeon dr. Doornwaard, I bump into the head of department when we are on our way to the briefing. He shows interest in my research, and so a conversation about the SSC starts, with an emphasis on the registration. “The biggest problem..” he starts off “is that it’s [EZIS] a bureaucratic system. It is not a medical system.” dr. Krijgsheer continues by explaining how the design of the system affects how doctors can do their work. “How the tabs are organised, the forms to enter the information, there’s nothing medical to it. There is no room to report information you as a doctor would want to. You can definitely notice that this system was designed by IT people, smart people for sure, but not medical people.” The way in which the checklist is digitalized, clearly allows and constrains activity patterns in particular ways. Clinicians feel that the artefact does not leave room to use the system according to their needs and preferences. As an anaesthesiologist noted: “The program only allows for ticking off standardized elements, and leaves no room for us to register what we’re actually doing.” The opportunity to only tick off the boxes – and proceed when done so – reinforces ostensive patterns of ‘organisational control’. The system is designed in such a way that it allows for organisational monitoring of processes, but not for registration of clinical information. Another anaesthesiologist adopted the saying “canalising versus excessive registration” [original: “kanaliseren versus kapot proctolleren”] to underline that professionals have nothing against registration per se. On the contrary, ‘canalising’ information by means of registration is valuable and even necessary for a smooth handover of information. Nonetheless, professionals should be able to do so on their terms. Respondents pointed out that system designers lack a ‘clinical view’, or as phrased by a gynaecologist: “They don’t speak our language, but they want to determine our behaviour.” The software system is perceived as an artefact that allows for registration, but not storage of clinical data. Since Plainsboro introduced a ‘bundle’ of artefacts to model the routine, it is vital to analyse the interrelation of artefacts in the arrangement; what do artefacts afford in relation to each other? Besides the digitalized checklist that serves the purpose of registration, posters were put up in the operating theatres as a memory support. The posters do not afford anything more than to ‘look at’. As 7