Marlot Kuiper

268 Connective Routines It is important to mention that in situations in which professionals decided to work around or without the checklist, they still considered that they thought was best and most safe for the patient. In their responses to incompatible demands, they relied on experience and professional judgment to work patient centred. This is in line with Tummers and Rocco (2015) who observed that professionals in rule-bending behaviour are moving towards clients rather than moving away from them. Routine Theory In this dissertation, I used Routine Theory to build an analytical framework to study how standards work. Although my main aim was to improve our understanding of how standards work in professional domains and I used routines as a lens to study these processes, the empirical findings allow me to further the literature on routines on three key aspects: (1) routine dynamics, (2) routine interactions and (3) the role of artefacts. Routine dynamics Ever since Martha Feldman and Brian Pentland conceptualized routines as systems with internal dynamics (2003), scholars focused on the question how routines generate both stability and change. Naturally, the model conceptualizing an ostensive and performative dimension is a simplistic representation of reality that serves the purpose of analysis. Nevertheless, a major shortcoming of this model is that is portrays the ostensive dimension as a single level of reality, which is “flat”, thus dismissing the existence of different (contesting) versions of the abstract dimension. The idea of “the ostensive dimension” inherently reflects agreement, whereas the findings of this study have showed the ostensive dimension in a stratified fashion. Indeed, the findings of this study are partly in line with the work by Dionysiou and Tsoukas (2001) who posited that a “single” ostensive dimension can be shared across actors. Ostensive aspects regarding ‘accreditation’ were firmly shared across actors and thus indeed show a single understanding. In later work, Pentland and Feldman (2005) acknowledged that the ostensive “may not be the same from person to person, from event to event or over time. Indeed, multiple and divergent understandings are probably more the norm than the exception” (Pentland & Feldman, 2005,p. 797). The findings of this study show that this is exactly the case, since there are different, and even contested understandings both within and across professional groups. This study contributes to the