Marlot Kuiper

58 Connective Routines Another category of procedural standards contain those that sharply define action items (Davidoff, 2010). A medical algorithm for example mostly refers to a decision tree; if symptoms A, B, and C are evident, then use treatment X (Johnson, 2002). The terms ‘protocol’ and ‘checklist’ are often used interchangeably, since they both help to remind clinicians of details that form baseline expectations of actions even when the care pathway is complex (Arora et al., 2016). Still, exact definitions of protocols and checklists differ, but as this dissertation focuses on the Surgical Safety Checklist , I will adopt this term, and concentrate the conceptual debate around this concept. (Safety) checklists There is no uniform definition of ‘checklists’ in health care. The most common general understanding is that a checklist is a cognitive tool that can help us to remember and perform tasks. These checklists can vary from as simple as not forgetting buying milk at the grocery, to commanding an aircraft carrier (Winters et al., 2009). Although checklists are generally understood as ‘memory aid’, the description of Winters et al. (2009, p.2010) reveals that there is something more to it: “A checklist standardizes the process to ensure that all elements or actions are addressed in a certain manner and order.” The phrasing ‘to ensure’ implies that ‘it has to be done like this’. A checklist thus consists of “sharply defined action items’’ (Davidoff, 2010, p.206) that prescribe how actions should be performed. Checklists are therefore much stricter procedural standards than guidelines that give some kind of ‘recipe’ (Hales and Pronovost, 2006). The kind of procedural standard depends on the complexity and contingency of the task to be performed. In ‘fuzzy’ situations, when situations are partly knowable, actions are contingent on others, and there are multiple decision points, loose standards such as guidelines and algorithms are suitable. In ‘clear cut’ situations, a steps-to-take-list - checklist - is often provided. (Davidoff, 2010). It is thus generally understood that checklists fit clear cut work circumstances. Checklists come in different types and can structure different phases of the work process. Some checklists are performed as background checks when planning an activity, other checks are performed immediately before a procedure is about to start, like the pilot’s before-take-off checklist (Shillito et al., 2010; Thomassen, 2012). The latter checks allow errors occurring at an earlier stage in the ‘causation chain’ to be detected. Such checklists are commonly called safety checks. Even safety checklists come in different formats. The most well-known and used example are ‘static sequential’ checklists that require verification