Marlot Kuiper

266 Connective Routines conflicting routine demands. Despite good intentions, the nature of medical work and surgical care in particular, make standardization problematic. In this case, ‘responsive operators’ better applies than ‘strategic operators’. A more recent theorization pinpoints towards a ‘hybridization’ of professional work – and beyond, arguing that a mixture of organisational and professional logics increasingly becomes ‘natural’ in professional work (Machin, 2017; McGivern et al., 2015; Noordegraaf, 2007, 2015). The results of this study suggest that this theorization at most applies to a few self-proclaimed ‘frontrunners’, who demonstrate a particular interest in optimizing organisational processes and see organising “as part of their job” (Noordegraaf 2015, p.16). These ‘hybrid professionals’ are often checklist project leaders who specifically opted for this task, and mostly get limited recourses (time) to work on the job. For the most however, ‘hybrid professionalism’ seems to reflect in ideas more than in practice. On an abstract level, professionals talk about organisational issues. They are aware of the bigger debates around patient safety, and the role of powerful stakeholders like inspectorates, accreditation boards and the news media. Doctors portray patient safety as an inherent part of their work, as “something they always have been doing”, but from a professional logic, they define it in different ways than how patient safety is defined from an organisational logic; standardized and thus transparent and uniform. For professionals, ‘doing patient safety’ still is something that is first and foremost inspired by experience and professional judgment. Despite their awareness of ‘organising’ and organisational issues, in daily practice, treating patients is at the core of most doctors’ work. There are tight schedules and severe time pressures, and professionals try to do what’s best for ‘their patients’. In doing so, they seem to overlook the bigger picture every now and then (organisation, coordination, prioritization). Surgeons for instance, are motivated to finish their program, and lack overview of what’s going on at the departmental level. They focus on finishing operations, but sometimes they go by on ordering blood or the next patient. Lastly, hybridity is associated with reflexivity. Professionalism is not about ‘solving competing demands’ as such, but about the development of the reflexive capacity to deal with them (Noordegraaf, 2015). When facing compatible demands, the results of this study point towards three strategies to cope with conflicting demands. A prominent strategy was to ‘work on it’, to try to make the