Marlot Kuiper

255 Conclusion Organisational routines thus can be conceptualized as practices with internal dynamics. A routine perspective is a convenient lens to study how standards work, since this perspective allows for a micro-level view on how routines evolve and change through daily interactions. A routine perspective does justice to both structure and agency, and explicitly conceptualizes work as a collaborative matter. The developed routine perspective explicitly focuses on internal routine dynamics, routine interactions, and the role artefacts play. The perspective I developed is further informed by literature from for example the Sociology of Professions to take account of the specific nature of professional work, and science and technology studies to take into account the specific nature of standards (resulting in figure 2). “How can professional standards in performance-oriented medical practice be studied?” (chapter 4) An ethnographic approach best fits the research question central to this dissertation. The research process is characterised by the activities headwork, fieldwork and textwork, that were performed in an iterative manner. Intensive fieldwork in which I conducted observations with a shadowing technique, held various formal and informal conversations, and collected different artefacts, allowed me to see how standards work in practice. “How do standards work out in medical teams?” (chapter 5) In the first empirical chapter of this dissertation, my analytical focus was on the internal dynamics of the checklist routine and drew four main conclusions. A first intriguing finding was that “the checklist” does not exist. The envisioned checklist routine is often portrayed as pretty straightforward, but the findings show that “the routine in principle” does not exist. Understandings of what the checklist is and should be are not only multiple, they are also contested. Some ostensive aspects are shared, for example when it comes to its importance regarding accreditation. The idea of the checklist as a tool to reduce mistakes on the contrary, is contested; whether the checklist is actually ‘evidence based’ and reduces mistakes is highly debated. These different ostensive aspects present both within and across professional groups. 8