Marlot Kuiper

16 Connective Routines In 2014, three-year-old toddler Carson Ayre made headlines in UK national newspapers because he survived a ‘miracle operation’. Carson was born with an extremely rare condition in which his heart’s chambers, veins and arteries which carry the blood were the wrong way around. A team of experts worked for about ten hours to perform the complex surgery in which all the veins and arteries were ‘re-routed’. After this radical intervention, the young boy’s heart was exposed through a hole in his chest for five days to reduce the swelling. After two weeks of recovery, Carson went home with his mum and dad with a bright future ahead of him. In 2007, a neurosurgeon with more than twenty years of experience performed an emergency operation on an eighty-six-year-old patient to treat the bleeding in his brain. The hospital where the surgery took place, a teaching hospital in Rhode Island USA, was considered the best hospital of the state. The surgeon did not check which side of the patient’s brain was to be operated in the medical form, assuring he would remember it. Unfortunately, he did not. The patient died a week later. The incident marked the third wrong-side surgery error in the hospital’s neurosurgery unit in six years. 2 The stories above paint two completely contradictory pictures of surgical care. The first is a very optimistic one; it tells about continuous developments in surgical care that lead to ground-breaking surgeries. However, astonishment with so called ‘miracle operations’ like Carson Ayre’s is often overshadowed by surgical mistakes. The second story is just one of many: “Surgeon accused of removing kidney from wrong patient” (Cohen, 2016, August 11),“Oops, wrong patient, wrong operation, missing clamp” (Montgomery, 2016, May 6), “Surgeon: ‘I amputated the wrong leg’” (Schalkwijk, 2014, April 4). These illustrative headlines from respectively the US, Canada and the Netherlands all reflect failures that had severe consequences. Failures that are often meaningfully labelled ‘preventable medical errors’ (Kohn, Corrigan, & Donaldson, 1999; McConnell, Fargen, & Mocco, 2012). A field that is capable of performing innovative, complex, and life-saving surgeries, paradoxically enough damages its own reputation by making preventable mistakes like wrong-side surgery. The past few years, there have been many attempts to do something about failures in care delivery. The American Institute of Medicine’s (IOM) report To Err is human (Kohn, Corrigan, & Donaldson, 1999) instigated a worldwide 2 These introductory stories are based on Pleasance (2014) and NBC News (2007) respectively.