Marlot Kuiper

265 Conclusion 8.6.1 Theoretical implications For this study, I used different bodies of literature to construct an analytical perspective to study how standards work inmedical practice. I will argue how this dissertation contributes to three bodies of literature (1) Sociology of Professions literature, (2) Routine Theory, and (3) Implementation Science, thereby focusing on what bodies of literature can add to one another. The theoretical strength of this dissertation mostly lies in the cross-fertilization of bodies of literature. Sociology of Professions The reconfiguration of professionalism In the introduction of this dissertation, I mingled into the debate on the ‘reconfiguration of professionalism’. There is no doubt various forces from both within and outside professional worlds, are changing professionalism. The direction of these changes remains disputed. Are professionals de- professionalised victims of standardization? Are they strategic operators trying to safeguard their autonomies and privileges? Are they hybrids naturally combining different logics in their work? Based on the empirical work of this study, I would say all is somewhat true. In some instances, medical doctors indeed portrayed themselves as ‘victim’, especially when it comes to registration of the checklist. Interestingly, medical doctors particularly have been depicted as ‘powerful’ professionals who have successfully safeguarded their autonomies (Freidson, 2001; Abbott, 1998). Although in many respects they demonstrate creative ways to cope with complex and often conflicting demands, medical doctors do not show the agency to do something about what they call a ‘registration burden’. They complain about it, detach it from their professional identity, but at the same time they are obedient in registration. It is “something they have to do”, and therefore they do it. Overall, professionals in this study did not show the capabilities to twist the debate about performance measurement into a for them favourable direction. This dissertation only finds limited evidence for the ‘professional as strategic operator’ thesis. Strategic work predominantly applies to boundary work safeguarding or strengthening a position in the team. Whereas scholars have been pointing to professionals as strategic operators manipulating standards to relief pressures from the ‘outer world’ (e.g. Levay & Waks, 2009), the chapter on routine interactions explicitly showed that first and foremost, decisions at the frontline are not ‘strategic decisions’ but rather ways to pragmatically cope with 8