Marlot Kuiper

168 Connective Routines 6.1 Introduction It is 7.55am when we enter OR8 at St. Sebastian’s. Today, I join dr. Liem, the responsible anaesthesiologist for operating theatres 7 and 8. The day in operating theatre 8 starts at 8.00am with the briefing led by the plastic surgeon who is about to perform a reconstruction of the right breast. During the extensive conversation, there are some hitches regarding anaesthesia. After the time-out we leave for OR7. It is 8.11am when we arrive at operating theatre 7. The Red Hot Chili Peppers are blasting from the speakers while the orthopaedic surgeon is already busy placing a knee prosthetic. “Doing fine here!” the surgeon says without being asked. The intervention is proceeding as planned. We leave to answer some e-mails in the staff room. The question central to this chapter is: “How does a (new) checklist routine relate to existing routines?” Although ‘the operation’ is the central and defining task of surgical work, surgical practice encompasses plenty of other practices around this core activity. Other practices that surround the operation are pre- and post- operative care, registration in electronic patient records, attending meetings, writing research reports, answering to e-mails, teaching juniors and so on, and so forth. To put the example of the previous chapter: professionals do not only have to take care of the soup, they also have to serve the salads and drinks. In the right place, at the exact temperature, and in just time. The introductory note of this chapter shows how the anaesthesiologist cannot be at two operating theatres at exact the same time to perform the briefing as part of the checklist routine, and consequently prioritizes the briefing and time-out in OR8, at the expense of these procedures in OR7. This chapter shifts the focus to the second part of the analytical frame (see figure 1,2) by illustrating how the checklist routine interacts with other professional routines, and consequently, how professionals deal with incompatible demands. This chapter starts off with an illustration of the checklist as ‘hub’. I explain how different professional routines have to come together in the performance of the checklist. In the paragraphs 6.3 and 6.4 I will show that this doesn’t come automatically though. I will explain how both ‘standard’ problems and unexpected events in routine interactions make the performance of the checklist difficult. In the final sections of this chapter I describe three main strategies