Marlot Kuiper

227 The artefact stipulates responsibility for the time-out procedure. Interestingly, responsibility for and direction of the procedure (patient?) are disentangled. The nurse anaesthetist is the actant to direct the procedure, but under responsibility of the surgeon. Specific actants are identified for specific items on the checklist; some have to be confirmed by the surgeon (intervention), others by the anaesthesiologist (known allergies) or scrub nurse (materials) for example. The final responsibility for the patient, is not indicated in the form. In the first part of the observation note in the previous paragraph 7.4.1 there was focused attention and active involvement of the team. In the second part however, it showed that only specific actants with a clearly indicated role involved in the procedure. In other words, clearly spelling out individualized responsibility in the artefact, might erode the sense of a shared team responsibility. Even though the artefacts spells out that the nurse anaesthetist should direct the time-out procedure, in none of the observed instances this was the case. Mostly the surgeon or surgeon in training initiated the time-out, by translating the procedure ‘time-out’ into a verb: “Shall we time-out?” [original: “Zullen we time- outen?”] As shown in the previous chapters, surgeons can herewith centralize their position in the team. Moreover, despite someone else is responsible for directing the procedure, surgeons strongly feel the responsibility for ‘their patient’, which makes them taking responsibility for the checklist procedure as well. In Plainsboro, they adopted the strategy to employ more artefacts to improve behaviour, rather than to alter existing artefacts. Earlier this chapter, I described the conversation with the scrub nurse that told me that they were informed that the boards were introduced and that “they had to be filled in.” The following observation note is from the very same day at vascular surgery at which the scrub nurse explained the introduction of the whiteboards representing the checklist rule. The surgeon starts the second time-out of the day. The patient is on the table, and is surrounded by the surgeon, the anaesthesiologist, the nurse anaesthetist and the operating assistant. Vascular surgeon dr. Huijs first checks the patient’s identity by asking for his name and date of birth, and checking the wrist ID. Next, he extensively explains what he is going to do, and he also indicates the surgical side and side. Thereafter he asks: “And you haven’t eaten?” 7