Page 63 - Journal of Management Inquiry, July 2018

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surgeons and those filling in the timeslots into the OTAP leg is moved to a patient’s jaw which had to be removed as part
about the usefulness of planning. The general feeling was of a cancer treatment. The procedure is done to make the patient
one of unquestioned usefulness. However, one concern was look somewhat normal again. And indeed what I see is a bloody
raised several times. When entering a new surgery into the mess. Part of the flesh around the right jaw is removed and the
tool, a standard time is set. This standard time can be changed surgeon works on the bone. I slowly turn as green as my suit.
in the mouse-over details of the created box that represents The manager of the operation theatres looks at the bloody jaw
with open flesh and blood everywhere for about half a second,
the surgery or by moving the box with the mouse. Both pro- nods satisfied and informs me that the operation will last for
cedures are tricky, as the graphical interface is not very another 25 minutes. I’m happy to leave the operation theatre
responsive to mouse movements. In addition, only a few with its manager.
interviewees were aware that they could enter the number of
minutes for a surgery directly via keyboard. The majority of . . . Later he adjusts—somewhat frustrated by the imprecision of
surgeons and anesthetists bemoaned that they had to use the the program’s responses to his mouse movements—the time of
standard times. The standard times were initially customized the surgery in the OTAP. It actually finished 25 minutes after he
before the OTAP was rolled out in the hospital, but regularly made the—correct—prediction. My jaw hurts.
misrepresents the anticipated and actual time needed.
Inscribing temporality and mindful organizing. The relation
These standard durations for surgeries hardly work out. I would between tool-based inscriptions of temporality and mindful
prefer that the tool would ask me how long I expect the surgery organizing is ambivalent. Some of the ambiguity can be
to take rather than predetermining a time slot. You see, it will explained by the two types of practices of inscribing tempo-
take longer if an assistant doctor performs the surgery or if I do rality, which not only influence the processes of mindful
it. (Interview Surgeon 12) organizing directly but also indirectly via influencing prac-
tices of inscribing the big picture.
Actors perceived their estimations of surgery durations Directly, the OTAP hinders mindful organizing as the
more precise than the standardized estimates because of their transformation of the unexpected into schemes does not
experience with the speed of their colleagues. Our respon- work out smoothly. The configuration of temporality via cat-
dents told us that they know their colleagues because the egorizations and standard time slots creates orderliness and
hospital is a rather small one. The German phrase “Ich kenne defines the baseline of what is expected to occur during the
meine Pappenheimer” was used in nearly every interview day—and it is against this background of expectancies that
with surgeons, nurses, and anesthetists, and describes the organizational actors revise plans, adjust resources, and
informal knowledge about the (lack of) abilities of their col- update interpretations while coping with unexpected events
leagues in a jovial and mildly degrading way. For example, a (see Patriotta & Gruber, 2015). We also find, however, that
surgeon remarked that “when the colleagues from the dento- this does not work out smoothly because the OTAP is slow,
facial department insert 2 hr, it will take 4” (Interview unhandy in use, prone to freezes, and bound to unrealistic
Surgeon 11). For surgeons, anesthetists, and nurses, this standard times. Consequently, the OTAP actually makes it
resulted in a flexible attitude toward the actual starting point more difficult for actors to remain sensitive to operations and
of their surgeries and in the need to directly assess what is reluctant to simplify interpretations. For example, if a sur-
going on by entering an operation theater. As one interviewee gery starts too late, clock time and event time are incongru-
remarked, “I take a look at the tool, say, 10 to 15 times a day. ent, which can be directly seen on the display: The red line
But I also go into the operation theatres by myself and have indicates that clock time “crosses” the box indicating the
a look because I cannot see how the other surgeries are pro- duration of a surgery, but the signal light indicates that the
gressing” (Interview Surgeon 11). The manager of the opera- surgery has not started yet. This diverts support staff’s atten-
tion theaters also makes use of this possibility and draws on tion away from what is going on to speculating about what
his experience with surgeries to predict deviations with a may have occurred or is occurring, even if it was common
high degree of precision. Here is a field note on such an knowledge to other actors that the estimate was often wrong.
assessment from shadowing the manager of the operation In theory, inscriptions that offer standard time slots are
theaters: inventories of established routines that serve as a repertoire
of actions that enable mindfulness at work (Levinthal &
This is the first time I enter an operation theatre since I got my Rerup, 2006). In practice, the relationship is more complex.
appendix removed as a child. I now look like a surgeon in the On one hand, standard times are likely to interfere with cre-
movies: all green with face mask and cap . . . The third operation
theatre I enter strikes me as the most gruesome one. A large ating a more nuanced appreciation of context as they do not
metal bin with bloody rags is close to the operating table where pay attention to situational specifics but treat different events
three or four people stand around. I’m told not to touch anything (e.g., experienced and unexperienced surgeons performing the
as everything is sterile. Grinning, the manager of the operation same surgery) as similar. The obvious misrepresentations of
theatres tells me that this is plastic surgery in which bone from a time and temporal progress counter the awareness of the big