Marlot Kuiper

269 Conclusion theorization of the ostensive, by producing a finer-grained understanding of the mechanisms underlying this stratification. A first explanation for stratification is hierarchy. Especially in highly professional domains such as surgical care, hierarchy is important for a clear division of tasks and responsibilities in executing professional work (Abbott, 1988; Diefenbach & Sillince, 2011; Freidson, 2001). Hierarchical relations in the surgery department are firmly grounded in a multitude of professional routines. During multidisciplinary handovers for instance, residents are asked to discuss the patients in a standardized way. Their supervisors pose critical questions as to educate novices, and interns quietly sit at the back row (see also Witman, 2008). The checklist routine envisions a team effort in which all participants speak up whenever needed, which is at odds with existing conversational routines. Hierarchical relations that are firmly embedded in existing routines make that different professionals have different agency, also when it comes to speaking up. Residents, interns and nurses have less agency to express their ideas, which means that some ostensive aspects at least become more ‘prominent’, which doesn’t necessarily imply that they are also shared. Ironically, it shows that especially those individuals that are considered highest in hierarchy, medical specialists, play frontrunner roles in breaking through these patterns and making the checklist a team effort. A second explanation can be found in the related notion of role taking (Mead, 1934). Especially in this professional setting, role taking demonstrated difficult. Role taking is important in forming joint action, as each individual has to align his or her action to the action of others by identifying the social activity in which they are about to engage and by learning what those others are doing, or what they intend to do (see also Blumer, 1969). The empirics of this study show that for medical specialist who were trained within professional segments, it might be difficult to place themselves into the roles of other team members to align tasks. In deciding whether or not to consult others, doctors work from their disciplinary perspective - their perspective on “their patient” - while role taking could be helpful in consulting others through a checklist routine. A third mechanism explaining stratification on the ostensive dimension is ‘connective potential’ and the possibility to construct shared understandings. The findings from this study for instance show that the frequency of encounters matters. Interestingly, in this case of a checking routine, frequent encounters seemed to facilitate shared understandings. However, the firmer these shared 8