Marlot Kuiper

257 Conclusion Whereas conceptualizations of hybrid professionalism coin ‘organising’ a central ingredient of professional work, this study found nuance empirical evidence. Fourthly, creating and understanding routines is beyond the scope of internal routine dynamics. The findings of this chapter are helpful for understanding routine dynamics, but also point towards factors that are beyond internal dynamics. For instance, artefacts (i.e. document ‘soup protocol’) that ‘wander around’ the surgical department visualize and strengthen ideas about organisational control, and prioritization of routines hint on the consequences of interacting routines. Hence, a focus on routine dynamics offers valuable, but partial explanations of how standards work. “How does a (new) checklist routines relate to existing routines?” (chapter 6) In the second empirical chapter of this dissertation, my analytical focus was on the interactions between the (new formed) checklist routine and existing professional routines. I drew three main conclusions. Firstly, practicalities can cause segmentation instead of collaboration. I found the interdependence with conflicting routines to be an explanation for variability in checklist routine performance. The routine connections as intended by the checklist are often not that straightforward and even lead to incompatible demands for professionals, and ultimately, segmentation. The findings show how irritations caused by practical matters, for instance because people simply have to wait for one another, ultimately reinforce more fundamental notions like ‘us’ and ‘them’. Secondly, implementation and (measuring) compliance are contextualized activities. It proves difficult to organise implementation processes in highly professional contexts that are characterised by multiple interacting routines, and participants that enter and leave the settings at different points in time. Even though meetings were organised to disseminate information about the checklist – that was considered ‘basic’ and straightforward, practicalities hindered attendance. Hence, creating shared understandings about the checklist was also practically difficult. This might have caused a situation in which so many different understandings (chapter 5) could emerge already from the beginning. After implementation, there is firm emphasis on measuring ‘compliance’. The findings of this study underline that strict compliance is not a feasible outlook 8