Marlot Kuiper

315 tasks is common within this strategy. The third strategy is to ‘work without it’, which can both refer to working without the checklist, and working without another routine. In such situations, professionals clearly prioritize one routine at the expense of the other. Chapter 6 concludes that professionals predominantly pragmatically cope with checklists amidst high-paced circumstances. The patients’ interest is decisive in on the spot considerations. Chapter 7 focuses on the connections between the checklist routine and artefacts. This chapter shows how artefactual arrangements are used to model the checklist routine, in which different artefacts with various possibilities for use are employed to steer professional behaviour. The artefacts reflect the organisation’s ostensive aspect. In an attempt to ‘optimize’ work processes, new artefacts are introduced, or existing artefacts are amended. These strategies are fuelled by pressures for more accountability, in which artefacts mostly focus on measurability and responsibilities. Artefacts are not ‘automatically’ translated into professional practice. Professionals experience various possibilities and constrains in using artefacts. A digital artefact embedded in the software system for example, is considered a ‘bureaucratic system’, and a paper checklist as ‘unprofessional’ and ‘outdated’. Nonetheless, these experiences not always align with actual connections artefacts can (help) create. For instance, the observations show how a paper checklist can be physically embedded in the routine, as it is easily transferrable. Still, the affordances of artefacts should always be considered in relation to each other. Despite a whiteboard can be incorporated into the process and allows for ticking off checked boxes, this artefact does not afford ticking off boxes as a matter of registration. In this way, this newly introduced artefact does not have added value compared to artefacts that already were part of the arrangement. Lastly, this chapter shows how artefacts (are used to) change social connections within routines. Surgeons for example leave a new artefact untouched as it is ‘not part of their professionality’, while scrub nurse take on the very same artefact to visualize their position in the team. All in all, chapter 7 shows that artefacts are not instrumental tools that lead to desired effects, but political tools that professionals pragmatically use, but that can also visualize and reconfigure social connections. Creating workable artefacts therefore is a constant, dynamic process that requires ‘trial and error’.