Marlot Kuiper

246 Connective Routines 8.1 Introduction This theoretical and empirical study focused on an important topic that has drawn worldwide attention: patient safety. Every now and then, journalists report so called ‘miracle operations’: The separation of conjoined twins, an operation on a premature baby’s spine to prevent disability, or an open-heart surgery on a young boy. These reports generate astonishment over the success of such highly complex, innovative team efforts. At the same time however, we read about ‘preventable’ surgical mistakes regularly: mixed up patient identities, wrong- side surgery, missing out on known allergies, and so on. A field that is capable of performing innovative, complex, and life-saving surgeries damages its own reputation by making preventable mistakes. The past few years, there have been many attempts to do something about failures in care delivery. The American Institute of Medicine (IOM) report To Err is human (1999) instigated a worldwide debate on patient safety and quality of service delivery. In the aftermath of its publication, standardization of practices was seen as one of the solutions. Standards endorse making elements of healthcare processes or outcomes transparent, uniform, comparable, and based on scientific evidence. Furthermore, because of increased complexity of cases, the demand for far-reaching specialization and collaboration go hand in hand. Therefore, some standards explicitly standardize team processes. Examples of standards in medicine are medication protocols, practice guidelines and team checklists. Both scholars from various disciplines and practitioners from the medical field have concentrated on the question how to effectively implement such standards in practice. Implementing standards proves a daunting task. Scholars from different fields aim to produce knowledge on this matter. In the medical field, studies tend to focus on the outcome of standards: Do standards reduce mistakes? Do in-hospital mortality rates drop? Other perspectives focus on effective implementation: How can standards effectively be implemented so that professionals comply? ‘Implementation gaps’ are regularly reported though. Scholars aim to identify factors that explain why standards are not (fully) incorporated into practice, distinguishing between for example individual factors and system level factors. In Sociology of Professionalism literature, the academic debate mostly concentrates around the ‘reconfiguration of professionalism’. Some scholars argue that professionals have become victims of all kinds of societal, political