Marlot Kuiper

156 Connective Routines patients’ to finish their tight schedule (see for example also chapter 6 about the construction of emergency). So, whereas in theoretical considerations of hybrid and organised professionalism ‘quality’ is conceptualized as multifaceted (e.g. Noordegraaf, 2015; Adler and Kwon, 2013), in empirics, professionals predominantly stick to individual case treatment, in which they mostly define ‘quality’ as a high quality intervention , thus focusing on the short term and confined to the core activity of surgical care. There were some exceptions though. The anaesthesiologist that was aware of the scope of the checklist beyond case treatment and did strive for building firmer social connections can be identified as ‘hybrid’ professional that does take organising team work beyond individual case treatment seriously. As hybrid professionalism is described as “not merely offering quality when cases are treated, but organising for quality becomes a central ingredient of professional work” (Noordegraaf, 2015, p.188), the findings of this study suggest a more nuanced (or, modest, if you wish) picture of hybrid professionalism. Yes, there is evidence for the involvement of organisational logics, but in daily routines ‘classic’ attributes of professionalism still seem to dominate. 5.6.4 Creating (and understanding) a routine is beyond internal routine dynamics Despite the findings of this chapter provide answers to the question how standards work out in medical teams, they also show that creating a routine and understanding how the routine works, is about more than the internal dynamics. This chapter already revealed how internal routine dynamics are affected by both routine interactions and artefacts. Firstly, the findings of this chapter suggest that the checklist routine (the abstract model and concrete performances) is affected by the connection with other routines that constitute surgical work. For instance, the findings point toward two different activities within the same routine; checking safety items and registering those. Doctors often already register the checklist before the actual performance. In doing so, they effectively use their time. This indicates that the checklist does not stand on its own, but has to fit with multiple tasks. If time wouldn’t have been an issue, there would be no stimulus to already register the checklist and quickly move on. Simply put, the checklist takes time and effort, and so do other activities. To gain a better understanding of how standards work, we thus not only need to take into consideration professionals’ thoughts on the checklist (i.e. “improves teamwork”, “reduces mistakes”) and their performances of this