Marlot Kuiper

22 Connective Routines questions. These lessons do not provide ‘implementers’, professionals, (or actors who consider themselves as both), with any knowledge on how to do this; how to involve supportive key actors, or how to develop workable accountability regimes, and even who then should be responsible for developing such accountability regimes. The issue with the “simple checklist” story is the assumption that a technical solution (a checklist) can solve a social and relational problem (see also Bosk, Dixon-Woods, Goeschel, & Pronovost, 2009; Mahajan, 2011). Solving this ‘implementation problem’ appears – ironically stated – a bit more complicated. 1.4 The professional as victim or strategic opera- tor? The implementation of new standards has not only been thoroughly studied in the field of implementation science that originates in the health care domain. The implementation of new standards has also gained considerable attention from scholars in the fields of organisation science and sociology that study professional occupations. In contrast with implementation scientists that heralded checklists to be a simple intervention, sociologists studying the professions and professional work have mostly emphasized that standards are complex social interventions. Standardization prompts fundamental transitions that affect the very nature, not only of professional work itself, but also of professional knowledge, identity, the way professionals are organised, and the ways in which they are held accountable (Evetts, 2011; Freidson, 2001; Noordegraaf, Schaufeli, & Schneider, 2015; Noordegraaf, 2016). Initially, from a sociological perspective implementing formal standards was seen as a means to further professionalise. Standards drawn from scientific evidence would advance the overall professional authority of medicine. Besides, standards like guidelines and protocols are developed by professionals themselves. The assumption therefore was that with the implementation of new standards, professional values and privileges would be maintained, since physicians are in charge of deciding what counts as scientific evidence (Hafferty & Light, 1995; Timmermans & Kolker, 2004). However, where standards used to assist professionals in their decision making, standards got more and more prescriptive over time explicating how professionals should act. The literature on professional work subsequently illustrated how these standards are seized by external parties for the purposes of accountability and control (Timmermans, 2005). From this point on, studies evolved in two separate ways (Numerato et al., 2012).