Marlot Kuiper

27 The challenge of working with checklists 1.6 Research aim and questions With this case study conducted in surgical care, I aim to better understand how and why standards work in highly professional contexts, and thus how they become a (routinized) part of professional work. This thesis focuses on the routines that are (re)formed after a formal standard is introduced in professional practice, and what actors do to maintain or change them. Further, I specifically look at how routines influence each other. The aim of this dissertation is to study the dynamics within and across routines as they are enacted in practice. Other than studies that focus on organisational control and adopt conceptualizations like ‘compliance’ and ‘adherence’ to standards, in this dissertation I explicitly study how professionals work with standards in situ , by tracing ostensive ideas and patterns of action. In doing so, I aim to provide a more in-depth and contextualized analysis that provides insights into the dynamic interrelation between ‘barriers’ and ‘facilitators’, and ‘individuals’ and ‘systems’. As the title of the book indicates, with a focus on professional routines I explicitly look for connections. One of the main arguments of this dissertation is that ‘working with standards’ is all about creating connections. Professionalism is in transition. This introductory chapter showed how developments internal and external to the professions push towards a (re)organisation of professional work. Complex cases require collaboration beyond firmly grounded professional borders. Trust in the professions and their services is not guaranteed. On the one hand, this leads to an emphasis on ‘better performance’, with well-managed, measurable and transparent performances. On the other hand, this leads to a stress upon ‘stronger professionalism’, with high-quality professional work and organised responses, not only to provide high quality, effective services, but also to legitimize professional work (Noordegraaf, 2016; Sanders & Harrison, 2008). Standards such as checklists might be seen as managerial tools, but also as professional interventions. In fact, they might be used to establish ‘connective routines’ in performance-oriented environments. How and whether this happens requires empirical analysis. Hence, connections are crucial and can take on different forms and appear at different layers. First of all, I study standards as a relational matter. The performance of a checklist routine is a collective effort and is thus all about how individuals come together, thus connect, in the performance of a checklist routine. I take a different approach than newspaper headlines that claim that “Not all surgeons [thus, individuals, Ed.] follow checklists that prevent bad mistakes.” 1