Marlot Kuiper

260 Connective Routines artefacts and accompanying tasks, or the other way around, by incorporating artefacts to visualize the professional role in the team. For instance, while surgeons perform boundary work by refusing an artefact that is not ‘part of their job’, scrub nurses take on the very same artefact to visualize and strengthen their position in the team. Further, other artefacts like furniture or equipment can create boundaries between routine participants. For instance, when sterile tables literally put professionals apart, connecting in the checklist performance becomes difficult. Fourthly, technology is a tool, not a panacea. Technological artefacts are increasingly adopted to create new routines. Participants even referred to other artefacts (i.e. a paper checklist) as ‘outdated’ and ‘unprofessional’. The data show however, that technological artefacts at the most interact with other artefacts, and do not determine patterns of action alone. Moreover, even though actants called the paper checklist ‘outdated’ and ‘unprofessional’, it mostly did stimulate mindful patterns of action, with focused attention by the team. On the contrary, technological artefacts offered less flexibility and enhanced feelings of control. The affordances of the various artefacts in the arrangement should therefore be taken into consideration. “How can connective routines be established?” The final sub question of this dissertation is about the implications of this study. How do the findings matter, and what did we learn about connective routines? In the section on implications I will provide answers to this question, differentiating between practical, theoretical, and methodological implications. A discussion of the personal implications of this study can be found in the final intermezzo ‘the reflexive professional.’ 8.4 Answering the central research question The previous section presented the conclusions of the various chapters one by one. This section takes the conclusions from these chapters together to provide an overarching answer the research question: “How and why do professional standards work in performance-oriented medical practices?”