The Rhetorical Life of Surgical Checklists: A Burkean Analysis with Implications for Knowledge Translation

Abstract

This dissertation uses the terms of Kenneth Burke’s dramatism to identify rhetorical aspects of surgical team checklists as they have been promoted, performed, studied, and surveilled. I argue that these terms can help to account both for the rapid uptake of checklists into policy and for their more variable effects and uptake into practice. I develop this argument by analyzing a large archive of texts published between 1999 and 2017, including popular media, news coverage, promotional campaigns, primary research, and other forms of scholarship. These published texts are considered alongside ethnographic fieldnotes from a study in which I collaborated to design, introduce, and evaluate an early version of a preoperative checklist at four Canadian hospitals. My analyses are guided heuristically by the first principles and central terms of dramatism, including action and motion; motive and situation; identification and division; attitude, form, and circumference. I use these terms to chart the early emergence of checklists within professional literature; to trace their rapid uptake as a standard of professional communication; to discern their multiple purposes and effects; to illustrate how and why they are enacted, accepted, and sometimes rejected in the operating theatre; and to locate blind spots in applied health services research. Taken together, these analyses demonstrate the importance of diverse rhetorical processes both to the uptake and to the basic functions of checklists. They also demonstrate the value and versatility of dramatistic terms. I contend in particular that the concept of rhetorical situation, as elaborated by Burke, holds significant potential for understanding and mediating the material and symbolic dimensions of practice and practice change. This dissertation points the way toward a uniquely rhetorical approach to the study and practice of knowledge translation in healthcare work.