Marlot Kuiper

276 Connective Routines research sites. For future studies, it might be relevant to more explicitly focus on differences in settings. In this study, I looked for what these hospitals had in common; geographical area, training novices, research, complex interventions. Besides the differences in size - Plainsboro is a remarkably larger institution - it might be worthwhile to study research settings that are very different to more clearly see different mechanisms at work. 8.6.3 Practical implications I conclude this dissertation by discussing what those working in professional domains can take from this study. As a Public Administration scholar, I value both theoretical development and sharing knowledge about the social phenomena tremendously. I will discuss recommendations for professionals, hospital boards (‘implementers’), supervisory organisations, educators and other professional services. Recommendations for professionals: Take notice of hierarchical relations and reflect upon them Engage in policymaking In this study, I focused on professionals. Therefore, I’ll start off with implications for those operating at the frontline. Ethnographic research is an exceptionally powerful tool for self-reflexive learning, as it provides a mirror in a social world in which opportunities for self-reflection are limited. Professionals usually do not see what they do. The narratives in this dissertation might function as mirror, reflecting their practices in context. Ethnography can thus be used both as a ‘model of’ and a ‘model for’ change (Dixon-Woods & Bosk, 2010). This work suggests that getting clinicians to watch and reflect upon their work practices provides them with input for creating connective routines. Two specific points resulting from this study are relevant to consider. Firstly, hierarchical relations clarify roles and responsibilities in this highly complex and dynamic domain. Interestingly, whereas the professionals in this study often assumed shared understandings about responsibilities, ideas actually were more scattered. Despite hierarchy is valued for accomplishing complex (Abbott, 1988; Ackroyd, Kirkpatrick, & Walker, 2007; Diefenbach & Sillince, 2011; Freidson, 2001), it might be worthwhile for professionals to be more reflexive about these processes, especially when tasks – like the Surgical Safety Checklists – require opposite patterns like ‘speaking up’. The conversations with