Marlot Kuiper

215 affords to tick off predefined boxes, paper generates the possibility to scribble notes. Professionals are not limited to only tick off predefined boxes – even though this is the intentional use by the designers - but they can more freely scribble on the paper according to their preferences. It was therefore no exception that professionals put additional clinical notes on the paper checklist. The flexibility in ‘drawing’ or ‘writing’ is also reflected in the following observation note. In chapter 5, I already wrote about the day on which I observed one of the orthopaedic surgeons in St. Sebastian’s who was about to perform seven knee scopes throughout the day on “all healthy people”. The following observation note illustrates one of those time outs. The patient is on the surgical table and the nurse anaesthetist is attaching the leg support to the surgical table to put the knees of the patient in the correct horizontal position for the scope. Dr. de Vecht walks towards the surgical table and shakes the patient’s hand. “Just some final checks before we get started” he says. After that, he asks for the patient’s name and date of birth, and he checks if it indeed is the right knee that causes the trouble. After reassuring the patient the intervention will only take about fifteen minutes, he walks to the computer at the side of the theatre, and grabs the checklist that was laying on the keyboard. He pulls a pen out of his jacket, and draws one continues, vertical line across all the items. The surgeon in this situation, performs some checks on the top off his head, and thereafter registers these checks, strikingly, by drawing one continuous line on the piece of paper. The predefined boxes in a software system like Plainsboro’s leave no other option than to tick off the items one by one (actual properties), the observation note shows how paper offers wider possibilities; one can tick off boxes one by one, make additional notes or drawings, and one can ‘tick off all the boxes’ at once with one continuous line. Interestingly, no other teammember commented on the stripe on the piece of paper, for example when handing over the patient to the recovery unit. Though the stripe visualizes that checks have not been performed one by one, or at least, that registration was done de-coupled from actual checking. In short, paper is considered ‘less professional’ and more vulnerable than a software system, at the same time there is a wide variety of ways to make marks on paper, which allows a flexibility far exceeding that available for software systems. Affordance only matters in relation to others; the perceived affordances 7