Marlot Kuiper

169 Checklist as ‘hub’: On routine interactions that professionals develop to deal with incompatible demands: work on it, work around it, and work without it. The chapter concludes with a discussion of the findings and the development of the second building block for the routine model in professional contexts. 6.2 Checklist as ‘hub’? In the previous chapter, I showed that a first and important finding was, that from all the many performances of the Surgical Safety Checklist I observed, not one repetition of the checklist routine was the same. The routine performances strongly varied, for example in the number of people that attended, how extensively the checklist was discussed, the extent to which participants paid attention, and who led the conversation. Despite there already were connections between professionals, these connections as envisioned by the checklist were not always self-evidently established. The previous chapter focused on internal routine dynamics, and I showed how different ostensive understandings led to different performances, and how performances in turn, adapted the abstract pattern. In the analysis, for example hierarchical relations and role taking were helpful in explaining the activity patterns that emerged. In other words, the previous chapter studied the checklist routine as a relational matter. In this chapter, I broaden the scope of the analysis. As indicated in the analytical frame that was introduced in chapter three (figure 2), this chapter focuses on routine interactions, as routines never stand on their own. The internal dynamics of routines are relevant to consider, but routines are inherently connected to each other. And to create a new routine, it has to ‘fit’ with existing patterns of action. To move beyond an ‘isolated’ consideration of the checklist routine, I explicitly conceptualized routines as practices that are shaped by interactions with other routines through their continuous performance (Schatzki, 2011). To understand such generative ‘bundles of routines’ I thus needed to analytically trace the connections between the routines. It was therefore necessary to consider how different actors are involved in the performance of various routines, so I could gain insight into what roles the different actors play in creating, maintaining or modifying routine connections (Nicolini, 2013). By shadowing different clinicians from different medical specialties for full working days, I got to know the various routines they engaged in. As I learned about the interaction of routines, clues about the varying checklist routine 6