Marlot Kuiper

277 Conclusion scrub nurses and residents particularly demonstrated the perceived central role of the surgeon in the team. The way in which the surgeon positions him/herself really mattered for the actions taken by the other team members. Surgeons who took the lead and centralized their position, downplayed the efforts and feelings of equity amongst other team members. If the surgeon on the contrary, managed to create a sense of an ‘equal team’, others were more inclined to speak up. Ironically, those considered highest in the hierarchy, are the ones to break through these patterns. Professionals in these positions, (senior) surgeons and/ or anaesthesiologist, should draw each other’s attention to their role and status in the team. Secondly, the findings of this study suggest that professionals may be more proactive when it comes to policy making and execution. Throughout the research process, I did find that professionals often do have (firm) opinions; they think, they feel, they struggle. Especially with regard to the registration of procedures they mention the burden it causes, while the gains remain limited. At the same time, they are obedient. They do things because they ‘have to’. Anonymized artefacts like the ‘soup protocol’ are wandering around the hospital and show professionals’ discomfort, but it stops there. I would suggest professionals to take a more proactive role in organising their work practices. Policies are not just induced from above, they are also for a large part what professionals make of them. The results of this study show how professionals try to be responsive on the spot and find creative ways to make policies ‘work’. Still, if they would more actively engage in constituting policies through ongoing conversations and trial and error, organising will increasingly become inherent part of their work, and less something ‘out there’ to deal with. Recommendations for hospital boards (i.e. ‘implementers’): Watch, see, and talk Look for local solutions This study also provides some recommendations for those who consider themselves administrator, policy maker or implementer. First of all, this dissertation promotes a sensitivity for the dynamics that are going on at the work floor. A great deal of the dissatisfaction clinicians show towards the checklist, is instigated by the feeling that only registration matters. In a complex play field with demanding stakeholders, registration numbers gain prominence. My advice would be: watch and see. Watch what people are doing, engage in conversations, 8