Marlot Kuiper

146 Connective Routines The third reason, is a more fundamental one and has to do with how professional work is monitored. Interestingly, in most conversations, professionals demonstrate a rather passive attitude when it comes to registration, it is something “they have to do”, while in the actual performance they proactively rely on their professional judgment and amend to routine to their needs and wishes. “They have to do it” because for the hospital board, the Health Care Inspectorate and the International Accreditation Committee, compliance to standards, such as the SSC, is of crucial importance. These institutes heavily rely on compliance rates, for example in deciding whether or not to prolong the accreditation. Most professionals do not want to “get in trouble” because of lacking registration, therefore they do it, as is visible in Plainsboro’s Intranet: Percentage correctly performed ‘stop moments’: 97,4% The phrasing on the Intranet gives the impression that for the organisation ‘performing the checklist’ and ‘registering the checklist’ is one and the same thing. The percentage still, does only provide us with information about the registration of the checklist. That indeed is very consistently done. The fact that actants do register procedures, does not mean they do so because they are convinced that it is a valuable activity. Rather, they see it as a considerable burden. At the end of the day of gynaecology outpatient treatments, I’m chatting with the surgeon to review the day. “Wait a sec”, he says. “I’ll e-mail you a document that perfectly reflects how it is. I don’t know who wrote it, but it is floating around and everyone feels it exactly like this.” Later that night I find the ‘soup protocol’ in my inbox (figure 9). The soup protocol reflects some of the abstract patterns. There is something about the tendency to standardize professional work as such, and the consequences for professional judgment (making soup based on a protocol rather than the chef’s expertise and sense of taste). But mostly, this artefact reflects understandings about the registration of practices (“you can tick off the boxes” and “Just Control Intensively” 5 ). The fear of ticking off the boxes and intensive control is that it distracts attention from the core process, treating patients, or put differently: “who cares about the soup?!” 5 JCI (Joint Commission International) is the best-known accreditation worldwide