Marlot Kuiper

230 Connective Routines Building on the argument of dispersed responsibilities; as responsibilities become ‘individualized’ or narrowed down to specific professional groups, this might ultimately lead to a reinforcement of professional borders - rather than creating connections. In chapter 5, I have explained how conflicting routine demands can lead to reinforced images of ‘us’ and ‘them’, for example when ‘we’ surgeons again have to wait for ‘them’ anaesthesiologists. In this chapter, I have showed how artefacts can strengthen these images. It can have to do with the design of the artefact itself, for instance when the responsibilities of professional groups are spelled out and emphasized, and not so much the team. It can also have to do with other artefacts in the theatre that intervene with the performance of the checklist. The surgical drape for example, creates a physical boarder between the surgeon and the nurse anaesthetist. For the nurse anaesthetist, it becomes more difficult to participate in the conversation. Images of ‘us’ and ‘them’ thus become physicalized through the surgical drape. Also the observation note above underlines the matter of spatiality. In this situation, the artefact around which actions concentrate is in the theatre where the team is operating. The anaesthesiologist however, has to move through the environment to engage in multiple procedures simultaneously. The door of the operating theatre literally appears as a physical boundary to engage in the procedure. The risk of door openings - and thus the motivation to keep it closed as much as possible - is materialized in the counting that is visible beside it. Professional borders are thus being demarcated through artefacts, but at the same time, these artefacts might be used to negotiate roles of these professional groups in the team. As surgeons and anaesthesiologists put the burdensome whiteboards aside, scrub nurses started to perform actions with this artefact. In doing so, the whiteboards served as a vehicle to make their role in the team more prominent. One of the scrub nurses told me: “the whiteboards help me to strengthen and visualize my role in the team.” This visualization of a professional role through an artefact closely relates to the residents that used the whiteboard to their patients in an attempt to come across as ‘professional’. To conclude, the artefact’s affordances do not automatically result in collaborative action. Especially other artefacts can mediate in connections among routine participants. At the same time, professionals do take on artefacts as a way to strengthen their professionality and role in the team.