Marlot Kuiper

313 assumption that individual behaviour only can be understood and matters in relation to others. The performance of a checklist routine is a collective effort and is thus all about how individuals connect in the performance of a checklist routine. Secondly, it is all about connections between routines. A surgical checklist routine does not stand on its own, but is part of a complex web of routines that constitute surgical work. Moreover, a surgical safety checklist explicitly strives to connect workflows from different professional disciplines. In order to understand the checklist routine, it has to be studied within its context. Thirdly, connections between artefacts and professional practices are essential. Artefacts are used to model and optimize the routine. Hence, connections between systems and professional realities at the frontline must be developed. In the chapters 5,6 and 7, the analysis is focused on each of these types of connections. To study a surgical safety checklist as routine, ethnographic research was conducted in two (mid)large hospitals within the same educational and geographical area in the Netherlands. Fieldwork predominantly consisted of observations, using a shadowing technique. Eighteen professionals from various disciplines (both anaesthesia and various surgical sub specialties) were shadowed for one or multiple full working days. In doing so, a comprehensive overview of the multiplicity of routines in which professionals engage on a daily basis (the context), and how the surgical safety checklist is part of that, could be sketched. During the observations, many conversations have been held with – besides those who were shadowed – various anaesthesiologists and surgeons (in training), scrub nurses, nurse anaesthetists, head of departments, managers and an inspector of the Health Care Inspectorate. Finally, various artefacts have been collected, including representations of the surgical checklist, policy documents, internal memos and e-mails. The research design is extensively discussed in chapter 4. Main findings Chapter 5 focuses on the internal dynamics of the checklist routine, in which the connections between people showed of crucial importance. Even though the checklist has been heralded for its simplicity in literature, there is no such thing as ‘the checklist’ in practice. What the checklist is and should be is ambiguous, and therewith anything but simple. The collective ostensive dimension consists of a variety of abstract ideas that are sometimes even conflicting. While the importance of the checklist with regard to accreditation is widely shared, ideas about the effects of the checklist on the reduction of mistakes, its evidence base