Marlot Kuiper

222 Connective Routines led an extensive time-out procedure, in which he first checked the items of the checklist with the patient, and subsequently instigated a ‘briefing-like’ conversation with the teammembers to discuss the preparation and instruments. These ‘briefing-like’ discussions are the exact subject of the second part of the meeting about altering the checklist. Mr. Bakker indicates that “it [the time-out] soon becomes some kind of process or instruction description” and “That’s not supposed to happen.” Dr. Laarakkers agrees. He noticed that increasingly, the time-out transforms into extensive deliberations in which the team members once again go over the procedure to perform. The manager has a clear view on the purpose of the artefact “The checklist should be a check list, not a free pass for extensive conversations”[emphasis indicated]. When we were waiting for dr. Laarakkers to arrive, and talking about my research project and standardization in general, the manager of the surgery department told me about his function and background. “I’m a historian by training” he says. “After that, I got into ICT somehow.” His background is thus not a medical one, but his perspective is seen as a valuable addition rather than a shortcoming. He argues that he can very well add to the discussions by introducing an organisational perspective; “also for the sake of efficiency.” In sum, the aim of both strategies to add or to alter artefacts, was to improve performances. Hence, artefacts are not static entities. On the contrary, artefacts can be modified and arrangements can be extended by adding new artefacts. What this actually means and what these performances look like, is subject of the next paragraph on artefacts in action. Table 5: Artefacts’ affordances P T0 P T1 S T1 S T2 Affordances Checklist embedded in software system (registration). Posters on the wall Addition of tabloid-sized whiteboards Paper checklist (registration) Altering the checklist “Bureaucratic system” “Out of sight” “Added value?” “Proof to patients” “Improving performance” “Vulnerable, dirty, lost” “Flexible” “Unprofessional” “Old fashioned” “Clarifying responsibilities” “Demarcating the conversation”