Marlot Kuiper

248 Connective Routines In the final chapter of this dissertation, I provide overarching conclusions and implications. First, I argue how we can interpret the findings of this ethnographic study in surgical care. After that, I will answer the research questions that were central to this dissertation. The conclusions from the chapters are used to provide some general reflections. In this chapter I ultimately aim to answer the final question of this dissertation: “How can connective routines be established?” Based on the research findings, I describe ways in which connective routines can be established, both in terms of professional practice and in terms of development of theories. Besides these practical and theoretical implications, I will discuss the methodological implications of this study. At the end of this chapter I will look back and forward by discussing some limitations of this research and some prospects for future research. 8.2 Why care about surgical care? In this dissertation I ethnographically studied how a safety team checklist works at two research sites, which I fictively called Plainsboro Teaching Hospital and St. Sebastian’s Hospital. Ethnographic research is particularly suitable to capture locally embedded knowledge and unravel situated routines. Indeed, by shadowing various professionals working in surgical care, I familiarized myself with their work routines. I got to know how they work with standards, but also how they perform operations, handover patients, conduct teammeetings, and chat over a cup of coffee (or two, or three). As I underline the situatedness of routines - and thus the situatedness of the findings, the issue of generalizability of substantive findings from this in-dept study to wider settings becomes a pertinent one. For example, what can other hospitals learn from this situated study? Or even, what can other professional fields working with standards learn from this study? First of all, there are certainly problems that are common to all surgical departments, because of the population that they treat and the tasks they have to perform. This inevitably in a wider societal context in which there is an emphasis on performance, with transparency of actions and accreditation as important matters. Different hospitals face similar tasks and challenges. As I conducted research in two different hospitals, I have been able to further reflect on commonalities and differences. The findings show commonalities for example in how professionals talk about and perform safety checklists, but also interesting differences for example in how artefacts (are used to) influence behaviour, and how team compositions matter. Interestingly, the findings of this