Marlot Kuiper

18 Connective Routines Fourthly, publicly exposed risks and incidents prompted both a political and public demand for more transparency and accountability (Millenson, 2002; Weick & Sutcliffe, 2003). Hospitals have to publicly account for mistakes that were made during hospitalization. Recently, this became reality in the form of a ‘public lecture’ in which both the responsible doctor and a terminally ill patient told their side of the story about what went wrong (Van den Brink, 2018, April 13). Last but not least, these increasingly complex cases have to be treated in an environment characterised by budgetary restraint. The steadily mounting costs of public service delivery – led by the healthcare sector – caused an untenable situation. Changing government policies, fuelled by the realm of the New Public Management, aimed at reforming the public sector of Western countries into a more business-like, efficient system from the 1990s onwards (Ferlie, Lynn, & Pollitt, 2009; Hood, 1991; Pollitt & Bouckaert, 2011). For example, the introduction of regulated market competition in the Dutch health care sector in 2006 put more emphasis on competition among care providers and customer choice (B. van den Berg et al., 2008), and schools and universities are increasingly funded by governments based on their performance (Versleijen et al., 2007). In short, in public professional service delivery there is an urgent call for quality, efficiency and collaboration, due to external pressures such as cost constraints, client demands and risks. These forces urge organisations to deliver innovative services. With the introduction of a business-like logic in public domains, the standardization of practices to make themmore objective, rational, and uniform became an influential mechanism to reform professional service delivery (Timmermans & Almeling, 2009; Timmermans & Berg, 1997, 2003; Zuiderent- Jerak, 2007). This study specifically focuses on the standardization of practices in surgical care for two main reasons. Firstly, professionals working in surgical care are considered the ‘archetypical’ professionals (see e.g. Etzioni, 1969; Fox, 1992; Freidson, 1988). Characteristic professional values like autonomy and empathy are argued to be most institutionalized in this specific domain (e.g. Jacob, 2017; more in-depth notes on professionalism can be found in chapter 2). Secondly, the healthcare domain is considered the precursor in standardizing professional work. The tendency to implement more and more standards in healthcare that are based on scientific evidence is firmly grounded in the scholarly literature (Grimshaw et al., 1995; Oertle & Bal, 2010; Parker & Lawton, 2000; Rycroft-