Marlot Kuiper

220 Connective Routines Plainsboro At the start of my observations in Plainsboro Teaching Hospital, there were posters on the wall visualizing the checklist, and there was the checklist incorporated in EZIS for the purpose of registration. When I returned at Plainsboro’s surgery department after a couple of weeks, a new representation of the checklist rule had been introduced in the meantime: the tabloid-sized whiteboard that needs to be filled in with a marker during the checking procedure. In this way, a representation of the checklist was literally brought more close to the process, and it also demands a concrete action: filling out the checks. It took a while before I noticed the whiteboard was there, however. Apparently it had been laying at the sides of the operating theatre, unused. Until a day at the vascular surgery in early February on which a scrub nurse told me about the whiteboard and explained to me where these boards came from: “Then at once, a month or so ago, there was this meeting organised for all OR personnel, and there they told us that these boards would be implemented. It was said: “From tomorrow onwards, there will be boards in the theatres, and you have to fill them in.” They also adapted the software system, so that we have to fill in our names, you have to fill in who registered.” The fact that a new artefactual representation was introduced in the operating theatres implies that the arrangement as it was, was considered “not enough”. The strategy that was used in Plainsboro to improve performances, was to add new artefacts. At least for this scrub nurse, it felt like the new artefactual representation was ‘induced from above’. At once, it was there, and it had to be incorporated in the process. Besides the introduction of a new artefact, there have been small amendments to the existing artefacts by linking actions to specific actants. In the software system, it no longer only has to be registered that safety checks have been performed, but it has to be clearly indicated by whom registration has been done. In this way, performances can always be traced back to specific actants. This strategy of altering artefacts was exactly the strategy that was employed in St. Sebastian’s.