Marlot Kuiper

226 Connective Routines The answer to this question is ‘yes’, since the anaesthesiologist confirmed two packages of blood during the time-out procedure, but this information did not get to the nurse anaesthetist who was chitchatting at the time. In short, when it is impossible to incorporate an artefact in the procedure, for instance because it’s out of sight, performances fit ‘routinizing checks’ rather than ‘routinizing the artefact’. Moreover, routinizing checks seems to be an individualized rather than a connected performance. The paper artefact can be taken to the surgical table and is used for coordinating the conversation. Still, there is a variety of possibilities to use this artefact. Performances show focused team attention, but also individual attention. Indicated responsibilities seem to point towards individualized rather than connected actions. The next sub section further explores the matter of ‘responsibility’ as inscribed in artefacts. 7.4.2 Clear responsibilities? In St. Sebastian’s, one of the strategies to ‘improve performance’ was to indicate more clearly in the artefact, who is responsible. ‘Stopmoment 4’ (Figure 17) represents the time-out part of the checklist and it indicates that: “the time-out is directed by the nurse anaesthetist (responsibility surgeon).” Figure 17: Excerpt time-out checklist St. Sebastian’s