Marlot Kuiper

26 Connective Routines material aspects that enable or constrain elements of routines. Artefacts can take on various different forms, such as written text, software systems, furniture or the physical setting. Many artefacts though, are material representations of a certain rule to steer a routine. Taking the example of the Surgical Safety Checklist, the ostensive aspects are how people talk about it, and what they think the checklist routine is or should be. The performative aspect is the actual performance of the checklist by the routine participants; it is what they do. The artefactual representation is the material form of the checklist rule, for example on paper, in poster format, or embedded in a software system. This conceptualization of routines as dynamic systems – rather than static entities – also implies that artefacts (no matter how carefully designed) not automatically generate the prescribed patterns of action (Pentland and Feldman 2008). For example, with the introduction of new standards the ‘implementers’ design the artefact to model the ostensive aspect of the routine, and shape the performances in a for themdesirable way. Still, when routine participants actually start working with the artefact, the performances are not necessarily what the implementers had in mind (ibid). One of the key ideas of routine dynamics is that routines emerge through their own enactment and in relation to other practices. A perspective of professional routines thus provides a more relational and contextual understanding of what actually happens when new standards are introduced in professional working contexts. Looking at professional routines provides valuable opportunities to go beyond the so called ‘implementation problem’. It allows for examining actual patterns of action and understandings – not just the proposed patterns reflected in artefacts. Since the concept of routines is the most micro-level concept among the collective level concepts (Becker, 2008), it enables to capture the dynamics in-between the individual and the system level. Routines encompass both structure and agency. This dissertation therefore departs from the assumption that the creation of new routines – e.g. the routine-uptake of a checklist – is a constant, relational, and dynamic process. Altogether, in this dissertation the point of departure is not “making standards work” nor “working against standards”. Rather, a routine perspective allows for an understanding of “how standards actually work.”