Marlot Kuiper

264 Connective Routines High-ranked professionals have the agency to translate their ostensive into practice, while for lower-ranked professionals this is less the case. For example, if an anaesthesiologist thinks the checklist facilitates teamwork but he is also expected to place a local anaesthetic, he will try to work on it and perform both tasks anyway. Another example, if a surgeon thinks the checklist is not evidence based, and he also has to attend his disciplinary handover, he will prioritize the latter and work without the checklist. Even though the scrub nurse in the team does think the checklist is evidence based, he/she has less agency to translate this idea into (connected) performances. If connections already exist, it becomes more easy to develop collective understandings and practices. High-ranked professionals play important frontrunner roles in using such connective potential. In sum, a (checklist) routine is a dynamic process. Though recognizable as ‘routine’, as recurring pattern, the routine is anything but static. Different ostensive ideas steer different practices, which are strongly affected by real- life circumstances. Through a routine, social relations are re-negotiated and reinforced. Artefacts that are introduced to create a stable pattern, actually allow for diversity as they direct behaviour in different and changing ways. 8.6 Implications of this research In this section, I will discuss the implications of this study. I will discuss the theoretical contributions to the different bodies of literature, and I elaborate on the added value of combining these bodies of literature, and what we can learn from it. Secondly, I will discuss the methodological implications. Thirdly, I will discuss the implications for professional practice. I will start off with recommendations for those who I shadowed; the professionals who work with checklists in their daily work. Next, I will discuss the implications of this study for hospital boards and those who consider themselves ‘frontrunners’ or ‘implementers’. Thirdly, supervisory and accreditation boards are important stakeholders for professional practice. I will give some recommendations for ‘measuring’ safety practices . Fourthly, some suggestions for medical educators will be provided. And finally, I will again broaden the scope and discuss some implications for other professional services in for instance law or education. In doing so, I will answer the final sub question of this dissertation: “How can connective routines be established?”