Marlot Kuiper

253 Conclusion different perspectives on checklists as entity; as (1) technical instrument, as (2) legitimizing tool, (3) as performance facilitator and/or indicator, and (4) as organised response, and their (hypothesized) effects on professional work and professionalism. In the field of healthcare and implementation science, scholars mostly approach checklists as ‘technical instrument’. Standards like checklists are seen as simple and cheap instruments that are easily transferrable to various settings. Most focus is on the outcomes of standards, that are assumed to automatically follow after implementation. Scholars that study professional occupations have mostly adopted quite the opposite perspective. In Sociology of Professions literature, there are predominantly accounts of procedural standards as complex social interventions, rather than simple technical interventions. Different theories on how professional work evolves through standardization developed from this perspective. On the one hand, standards are seen as ‘legitimizing tool’. Evidence based standards are argued to increase the status and self-esteem of the professions. From this perspective, checklists are seen as tool to gain legitimacy and further professionalise. On the other hand, these same standards are by sociologists identified as performance facilitator and/or indicator. Despite checklists might be helpful in dealing with complexity, they open the doors to outside control. The creation of checklists creates a window of opportunity to assess professional practice, as outsiders can monitor adherence to checklists and compare performance. Lastly, checklists can be considered an organised response to new service realities. In this view, checklists are ‘inescapable’ as professionals need to take organising patient safety seriously. Safety is no longer about taking care of individual patients, but about responding to increasing complexity and information, risks, and demanding clients and society at large. As argued earlier, theorizations of ‘hybrid professionalism’ and ‘organised professionalism’ move beyond the idea that formal standards focusing on efficiency and accountability are unnatural for professionalism. From this perspective, safety checklists are inherent part of professional work. Classic professional values like personal case treatment and solidarity are maintained, while new demands like effectiveness and efficiency are simultaneously taken into consideration (Noordegraaf, 2011, 8