Marlot Kuiper

314 Connective Routines and effects on teamwork are highly debated. These diverging abstract ideas result in two separate patterns of action. On the hand, registration of the checklist is consistently done for the sake of performance measurement. On the other hand, the actual performance might deviate fromwhat has been registered. In practice, the performance is more ‘loose’ than the checklist prescribes. For instance, items are covered in a varying order, the checklist is often performed frommemory, and different professionals take the lead and initiative in performing the checklist. Chapter 5 offers explanations for varying routine performances. Surgical teams are characterised by clear hierarchical structures. Those professionals with a high-rank in the team, like (senior) surgeons and anaesthesiologists, are able to translate their ostensive aspect into collective performances. Those lower in hierarchy, like scrub nurses and nurse anaesthetists, show less able to bringing their individual ideas to a collective level. Scrub nurses for instance show aware of disruptions in the routine performance, but they are inclined to perform actions individually, rather than they speak up about it. Besides, the ‘connective potential’ proves of crucial importance. Checklist do not create connections between people. Rather, connections are a requisite to make standards work in practice. Actants in a high position play a key role in utilizing and further developing social connections. Notably, firm social connections, for example present in highly specialized teams, might ultimately undermine the ‘checking’ nature of the checklist. If people in the team entrust one another on ‘how they work’ this might prelude systematic checking of safety items. Chapter 6 focuses on connections between routines. These do not emerge easily. Even though the checklist has been introduced to form an important ‘hub’ in which various professional routines connect, the complex, dynamic context of surgical work makes it hard to establish connections. In practice, the combination between expectations aroused by the checklist, and expectations aroused by a multitude of other professional routines leads to almost ‘impossible situations’ for professionals. This chapter distinguishes between ‘standards problems’ and ‘unexpected events’ that lead to conflicts between routines. Professionals constantly have to set priorities, construct emergencies, and negotiate responsibilities. In this chapter, three strategies that professionals use in an attempt to meet all these expectations are presented. A first strategy is to ‘work on it’, which can be best described as ‘as trying to unite the incompatible anyway’. This strategy proves the least fruitful, but most stressful for professionals. A second strategy is to ‘work around it’, in which professionals work around formal rules because this seems the most favourable and safe option to them. Delegating