Marlot Kuiper

247 Conclusion and technological forces, hence, through standardization they become ‘de- professionalised’. Others have typified professionals as strategic operators that actively aim to maintain or restore their position, for example by resisting or manipulating standards. A more recent theorization does not see an organisational logic (with values like objectivity and transparency) and a professional logic (with values like autonomy and collegiality) as inherently opposed to each other. Rather, hybrid professionalism theorizes blending logics– even to the extent that this feels ‘natural’ for professionals. How hybridization unfolds in practice needs further empirical investigation. With this study, I respond to recent calls to study on a micro-level how professionals within organisational environments actually give shape to new standards in the everyday course of their work (e.g. Denis, Ferlie and Van Getsel, 2015; Wallenburg et al. 2016; Waring & Bishop 2013). The purpose of this thesis is to contribute to new knowledge of these issues through an ethnographic study of a specific standard, a surgical safety team checklist, in two hospitals. The rationale behind this thesis was that we know little about the everyday work with standards. I decided to take a different perspective than outcomes or implementation, by asking the question how standards actually ‘work’ in practice. Put differently, in this dissertation I studied how patient safety is ‘done’, focusing on a safety checklist for surgical teams. Routine Theory was used to develop a research perspective. Based on the conceptual model by Feldman and Pentland (2003;2005;2016) I argue that standards are about making connections at different levels. First of all, a surgical team checklist aims to make connections between professionals in the performance of the checklist. Secondly, the performance of a checklist has to connect to existing practices in order to ‘fit’ in the organisation of professional work, and thirdly, representations of the checklist like posters or whiteboards, I call them artefacts, have to connect with practices to stimulate mindful practices. The central question to this dissertation is: “How and why do professional standards work in performance-oriented medical practices?” With this dissertation I contribute to an improved understanding of how standards work in surgical care, and also contribute to the development of theories on the reconfiguration of professionalism and organisational routines. Although this dissertation departs from a different perspective than ‘implementation’, insights into how standards work might be inspirational for theories on how to, or not to, ‘implement’ standards in organisations. 8