Checklist as Hub: How Medical Checklists Connect Professional Routines

Checklists were introduced in the medical domain as simple procedural interventions that enhance patient safety. However, these checklists are often not translated into actual work routines. To better understand why checklists become routines or not, I specifically traced the interaction of checklists with existing professional routines. Professional work is structured by these routines that inhabit professional norms and values. Although checklists ask for connections between multiple professional routines, they often lead to incompatible demands for professionals. The interdependence with conflicting routines was found to be an explanation for variability in checklist performance. Clinicians developed three responses to deal with conflicting demands: work on it, work around it, or work without it. This study underlines the need for another perspective on medical checklists; they are not ‘simple’ coordinating instruments, but ‘hubs’—points where multiple and different professional routines have to connect.