Marlot Kuiper

258 Connective Routines in professional contexts with multiple interacting routines. Not attending the checklist might very well be the outcome of mindful consideration and coping with multiple demands. Thirdly, professionals work on it, around it, and without it. Working with multiple routines requires prioritization, constructing emergencies and negotiating responsibilities. Rather than standardized responses, incompatible demands require responsiveness. I derived three overarching responses professionals have developed to deal with incompatible demands: work on it, work around it, and work without it. Work on it reflects the strategy to try to manage two conflicting processes anyway, for instance when one routine participant is required to participate in two different routines simultaneously. In such situations, professionals do not prioritize one routine over the other, and to their best to be at two places at the same time. The result however, is often considered disappointing as both demands aren’t met. Where in other domains ‘work on it’ might mean work overtime to get things done, in the surgery department the conflict often arises because actions have to be performed at the exact same time. Work around it reflects the strategy to work around formal procedures and adjust to situated routine demands. This strategy of workarounds is often reported in the coping literature. In this study workarounds involved completing tasks at different moments than formally demanded in the artefact, for example by registering tasks before they have been executed. Work around might also mean outsourcing tasks to other routine participants that formally do not have the responsibility to execute those. Work without it reflects the strategy to explicitly making a choice for one routine over the other, thus prioritizing tasks to deal with incompatibility. Work without it might mean working without the checklist, but it might also mean working with a checklist but thereby casting aside other tasks. These responses often entail ‘on the spot’ decisions; there are no formal routines for prioritization and professionals decide on the spot whether they are going to work on it, around it, or without it. Professionals have to negotiate who is responsible for the various tasks and ‘Emergency construction’ becomes a powerful game for prioritization.