Marlot Kuiper

271 Conclusion patient”, but how this formal responsibility translates to the checklist procedure remained rather vague. Things started to become more complex when in chapter 6 the focus was on routine interactions. The strategy to work around procedures was used to deal with conflicting routine demands. Anaesthesiologists for example outsource the performance of the time-out to the in-room nurse anaesthetist as they can’t be at two places at the same time. Still, formal responsibilities are with the medical specialist who is then not present, but supervising. In the performance of the time-out, individuals are involved that have no formal responsibility for the patient or operational procedures. When responsibilities are scattered throughout intersecting routines, what these responsibilities actually are and to who they belong, becomes more complicated. Artefacts In Routine Theory, the role of artefacts increasingly draws attention (e.g. Pentland and Feldman 2008; D’Adderio 2011; 2014), scholars seem to have overlooked their social identity as being a property of the organisational routine as a whole rather than its participants (Runde et al., 2008). By borrowing from Actor- Network Theory (e.g. Latour, 2005) and Gibson’s (1987) notion of affordances, I have been able to identify artefacts as actively constructing the social world. The focus on affordances flows from the idea that artefacts are neither ‘things’ that determine human behaviour (deterministic view), nor are they things that are what their users make of them (social-constructivist view), but artefacts do set limits on what is possible to do with, around or via the artefact (Hutchby, 2001). This perspective allowed me to identify artefacts as objects that (re-)negotiate roles and responsibilities. On the one hand, medical specialists tended to put aside new artefacts, herewith drawing a strong boundary of what does, and what does not belong to their professional activities. On the other hand, scrub nurses incorporated these very same artefacts to visualize their position in the team. The very same artefacts are thus used for different purposed by different actants. A second observation is that while artefacts are most associated with stability (D’Adderio, 2011) they demonstrated rather fluid in this study. Artefacts were amended throughout the observations, for instance by more explicitly stating responsibilities. Artefacts thus not only change routines, they are dynamic and change as well. ‘Optimizing’ artefacts proved a daunting task, ‘what works best for now’ seems a matter of trial and error, but the findings suggest that a strategy 8