Marlot Kuiper

206 Connective Routines 7.1 Introduction After the second surgery of the day, I follow anaesthesiologist dr. Liem to the recovery at St. Sebastian’s to hand over the patient. When we get there, the nurse immediately starts to connect the patient to the monitors, while dr. Liem scours the sheets. “Sh*t” he sighs. “I forgot the checklist, must be still in the OR. I’ll be right back.” A couple of minutes go by. The nurse restlessly hips from one foot to the other. At the same time, she tries to start a conversation with the patient who is about to wake up: “Hello mr. Van den Broek, the operation is finished. Everything went well. You can wake up now.” Mr. Van den Broek opens his eyes for a second, and then closes them again. “Mr. Van den Broek, open your eyes!” the nurse repeats, articulating more clearly. Then dr. Liem returns, waving with a wrinkled piece of paper. “Got it!” He immediately starts to handover the information to the nurse: “This is Mr. Van den Broek, who just underwent a cholecystectomy.” While dr. Liem is talking, he tries to wipe away the drip of blood that is on the checklist. As a result, a red stripe now adorns the piece of paper. After the handover, dr. Liem stuffs the checklist between the sheets on the bed, and then we move to the holding to get our next patient. This chapter is about the role that artefacts play in creating and recreating connective routines. In the previous chapters, I subsequently focused on the internal dynamics of the checklist routine, and the interaction of the checklist routine with other professional routines. In these empirical chapters, different artefacts, different representations of the checklist more precisely, already passed by in different ways. For example when discussing the registration of the checklist in the software system, or talking about clinicians holding a paper checklist or memory board in their hands. So far, several studies have acknowledged that material and immaterial resources are important for constituting, maintaining and changing routines (e.g. D’Adderio, 2008, 2011; Edmondson, Bohmer, & Pisano, 2001; Howard-Grenville, 2005; Turner & Fern, 2012). However, artefacts are rarely the focus of analysis, and there is no comprehensive framework to study how artefacts affect routines. In this chapter, I shift the analytical focus to artefacts. The research question central to this chapter is: “How do artefacts affect how standards work in medical teams?”