Marlot Kuiper

249 Conclusion study suggest that differences not necessarily occur between hospitals, but rather between surgical teams. Practices by a thoracic surgery team in Plainsboro were more similar to practices by a surgical team in St. Sebastian’s, than to a general surgery team in Plainsboro. The frequency of team interactions appeared as a vital matter, both in terms of creating shared understandings and sustaining a pleasant work atmosphere. At the same time, the artefactual arrangements led to differences at the hospital level, as the hospitals adopted different artefactual arrangements and different strategies to improve those. Hence, the situated findings cannot be ‘transferred’ to other contexts one-to-one, but a discussion of how things are done ‘here’ provides professionals an opportunity to reflect how they are doing things ‘there’. In the section on practical implications in this chapter I will go further into this matter of reflexivity. Secondly and taking it a step further, I introduced surgical care as an exemplary case in the first chapter of this dissertation. This ethnographic study allows me to make inferential generalizations (Mortelmans, 2007) that go beyond the field of surgical care and capture ‘standardization in professional services.’ In public professional service delivery at large, there is an urgent call for quality, efficiency and collaboration, due to external pressures such as cost constraints, client demands and risks. With the introduction of a business-like logic in public domains, the standardization of practices to make them more objective, rational, and uniform became an influential mechanism to reform professional service delivery (Timmermans & Almeling, 2009; Timmermans & Berg, 2003; Zuiderent-Jerak, 2007). Given that medicine is widely recognized as a profession with distinctive characteristics and composed of different segments each having their own taken-for-granted ways of acting and talking, the changes that have occurred in this domain are likely to be indicative of what is also happening in professional organisations in other fields like law and education. I took standardization in surgical care as a case, since this case was likely to “yield the most information and have the greatest impact on the development of knowledge” (Patton, 2001, p. 236). Thirdly, I would argue that the constructs I developed in this dissertation, such as the strategy to ‘work on it’ (chapter 5), are not merely strategies that are adopted by professionals in surgical care, but also by other professionals that face conflicting demands in the executing of their everyday work routines. Also the notion of an ‘artefactual arrangement’ for instance, could very well apply to other professional domains like law or education. I therefore can make 8