Marlot Kuiper

155 How standards work out in medical teams: On routine dynamics Further, this chapter shows that connections do not so much result from standards, but are a perquisite for using standards. They can be better considered as ‘effortful accomplishments’ (also Feldman et al. 2016), rather than automatic outcomes of artefacts. There must be some ‘connective potential’ when standards for making connections are used. As shown, high-ranked professionals play important frontrunner roles in order to exploit such ‘connective potential’. When they set the tight tone and stimulate others to collaborate, checklists are used differently, both in terms of ideas and actions. Professionals themselves rather than checklists establish collaboration, but checklists are important devices for actually using such connective potential. It has been commonly assumed that most of the barriers to effective implementation, such as negative attitudes, operate at the level of the individual health care professional (Grimshaw, Eccles, & Tetroe, 2004). An observational study by France, Leming-Lee, Jackson, Feistritzer, and Higgins (2008) on the compliance to a surgical team checklist for example, focused on the ‘engagement’ of individual professionals. Although this chapter shows that individual attitudes do matter, from the analysis I claim that they only exist, change – and thus matter, in interaction with others. This analysis from a routine perspective underlines the collective, and therefore social nature of working with standards. 5.6.3 Hybridity is not yet ‘natural’ In the theoretical chapter of this dissertation, I introduced the notion of hybrid professionalism, a rather new theorization of professionalism in which ‘classic’ professional logics are combined with organisational logics. In theory, contradictory professional and managerial principles such as autonomy and control, or quality and efficiency are combined in order to establish contemporary professional actions (Noordegraaf, 2015). Standardization in professional domains, and thus the introduction of a safety checklist in the surgical domain more specifically, can be considered a proper case to empirically trace what ‘hybrid professionalism’ looks like in practice. The observations did show how professionals are working with broader ‘organisational themes’ like patient safety, also directly linked to accreditation. They are aware of the (politically) demanding environment they are operating in (not just literally). Nonetheless, in daily practice, they tend to focus on individual case treatment, emphasized with notions of “my patient”, and herewith neglect the overarching organisation of surgical care. Indeed, individual case treatment can even instigate conflict among professionals since they want to prioritize ‘their 5