Marlot Kuiper

267 Conclusion impossible possible. While in some cases professionals demonstrated responsive towards competing demands by working around formal standards, they also often lacked a reflexive overview. When talking about reflection, noteworthy is the development of the debriefing as a fourth part of the Surgical Safety Checklist. When I was conducting the fieldwork, ‘project debriefing’ was in development. The idea was to make debriefing a routine concluding each operation. “How did it go?” “What can we improve?” “Who wants to share feelings?” should become standard questions evaluating the procedures. Still, debriefing is not part of the observations as reflected in this study. In the very few instances one of the team members tried to initiate a debriefing by asking: “Who would like a debriefing?” none of the other team members responded positively. Hence, no debriefing was observed. Especially in dynamic domains and when schedules are tight, it proves difficult to organise reflection-in-action (Schön, 1983). Coping The results obtained in this study may have implications for understanding coping. In street level bureaucracy literature, the question how frontline workers (i.e. professionals) cope with work pressures is often the central question (Lipsky, 1980; Tummers et al., 2015; Tummers & Rocco, 2015; Zacka, 2017). Coping is about behaviour, about what actors do at the frontline when executing policies (Tummers et al., 20015; Tummers & Rocco, 2015). As I observed frontline doctors facing conflicting demands, I can contribute to the coping literature. ‘Workarounds’ are frequently observed in studies on coping. In this thesis, I found doctors bending rules to produce desirable outcomes. Besides, ‘work without it’ or ‘rule-breaking’ as defined in coping literatures surfaced, but on a smaller scale. A less known strategy that was repeated several times throughout this research, was the strategy I called ‘work on it’. When confronted with conflicting demands, many professionals in this study did not decide to bend or break rules, but to unite the ‘impossible’. They were trying their best to make things work on the spot anyways. As one can assume, wasn’t the most fruitful approach. Although studies on coping depart from the assumption that professionals adopt creative and, if necessary, rule-breaking strategies to deal with pressures, this study underlines the possibility that professionals not only work around or work without procedures, but actively work on policies striving to make the impossible possible. 8