Marlot Kuiper

223 7.4 Artefacts in action In the previous paragraphs, I have analysed the material, spatial and temporal properties of the artefacts that are adopted by Plainsboro and St. Sebastian’s to model the checklist routine. These (perceived) properties of artefacts affect how they can be used in practice, or in other words, what routine can be developed. If an artefact is out of reach or out of sight, professionals cannot adopt it in their routine. If an artefact does not afford to store clinical information as wished for, they will likely put it aside. Artefacts were introduced, added and altered to model the checklist routine, but when taking their affordances into consideration, how do these artefacts actually model routines in the context of everyday work? 7.4.1 Focused attention? Most simply and narrowly stated, the Surgical Safety Checklist had been introduced to reduce surgical mistakes. The assumption behind the checklist was that if the team as a whole would focus on safety items as inscribed in the checklist at critical moments, mistakes would be reduced. Already in chapter 5 on internal routine dynamics however, I discovered that though goals and purposes seemed simple at first hand – at least from an organisational or ‘implementers’ perspective, they were not that clear and uncontested in reality (plurality on the ostensive dimension). One of the fundamental ‘debates’ that occurred, was whether ‘the checklist’ should be routine, or that ‘checking safety items’ should be routine. More precisely stated; should artefact use become routine, or should the artefact be just a tool to make checking for safety items a routine? The following observation from Plainsboro underlines how the artefacts’ affordances are key in constituting a routine. At my very first observation day at Plainsboro, I shadow the gate-keeper. At one of the two theatres we are monitoring, the surgeon is performing four urology interventions over the course of the day. The third patient just installed himself on the surgical table when the urologist instigates the time-out: “So, you are sir De Boer, born 12-04-1962”, the surgeon says while looking at the patients’ wrist ID. Without waiting for further confirmation, he continues: “You are here for a cystography. And you have no allergies. Okay, fine.” 7