Marlot Kuiper

218 Connective Routines Still, to some professionals the affordance to show the whiteboard to patients is of importance. The whiteboards make the checklist rule visible, and this procedure can be brought and shown to patients. The perceived need to inform patients about the procedure, and apologize for again checking for these items is reduced (see also chapter 5). The whiteboard visualizes the routine of checking items, and so also patients can see that this is routine, and not a lack of ‘professionality’. This seems to apply mostly to junior professionals (in training). St. Sebastian’s This chapter started with an observation note shadowing anaesthesiologist dr. Liem in St. Sebastian’s. While he scoured the sheets, he sighed “Sh*t, I forgot the checklist, must be still in the OR. I’ll be right back.” The introductory note of this chapter illustrated a part of the checklist’s journey throughout the hospital, and illustrates how it easily can get forgotten – and it takes quite some time to get it – and how it easily gets dirty and damaged. In short, it has to survive its whole journey throughout the hospital. In quite some instances, the checklist got ‘lost’ for a while somewhere throughout the process; it was left at the corner, on a stool in the theatre, next to the computer, or between the sheets. This affordance of ‘wandering’ becomes extra critical, as there is only one copy of the checklist; one physical piece of paper that can only be ‘accessed’ at one location at the same time and cannot be replicated. Still, the paper checklist can be taken to any location in the hospital, for example for the sake of deliberation. It has shown less interruptive for team deliberations to jot down information on a scrap of paper, than it is to input on a computer at the back of the theatre. Observation notes from St. Sebastian’s showed how the paper artefact can be brought to the centre of attention; the surgical table. The actant who leads the time-out procedure, usually the surgeon, sometimes the anaesthesiologist, can take the checklist to the surgical table to easily communicate with the team members and the patient. Still, the surgical table is where actions concentrate. Materials are being prepared, the patient has to be connected to the monitors. These artefacts that are in the room and are required for the surgical intervention, can act as blockades for team members to gather around the surgical table and participate in the time-out procedure. Especially with the more complex orthopaedic interventions where patients are provided with protheses, the operating theatre is full of sterile tables on which all the equipment that is needed for the intervention is put on. Team members cannot pass these objects, which makes it more difficult to participate in the