Marlot Kuiper

280 Connective Routines on how a checklist is being performed, start conversations with actors in the field exchanging ideas on how checklists should be performed, rather than counting how often performance is registered. It might be valuable to look for new accountability measures that exceed ‘ticking the boxes’ and do justice to the complex reality of surgical care. I would suggest that in developing such measures, professionals themselves would be involved. It is not so much a matter of ‘trust in professionals’, but of entrusting them in co-creating accountability. Other professional services: Strive for standardization through flexibility Consider the embeddedness of routines Co-create workable artefacts In this dissertation, I took surgical care as a suitable field to study standardization of professional work. As this study allowed me to make theoretical generalizations that have explanatory power for other settings as well (Mortelmans, 2007), I can also discuss some implications for other professional fields. Still, I explicitly claimed that there are no ‘general lessons’, as practices are always contextualized and gain meaning through practices. Hence, the implications for other professional fields remain on a rather abstract level. A first general implication for professional fields is that although standardization might be valuable in dealing with complexity and creating stability patterns, one should never strive for rigidity. This thesis has convincingly shown that professional practice is characterised by tasks that are hardly standardizable, and that professionals pragmatically cope with complex, sometimes conflicting routine demands. It might be worthwhile to rethink the notion of ‘compliance’ to do justice to the demanding and unpredictable nature of professional work. Sometimes, working around or working without standards might be the best solution at hand. Therefore, I would recommend to strive for standardization while allowing for flexibility. Secondly, this thesis has shown how practices are inherently interwoven. In ‘implementing a new standard’ there shouldn’t be isolated focus on that specific standard (is there an evidence base? does it work?) thereby neglecting the multiple professional routines that constitute work in professional domains. A new standard usually is just one of many (new) standards, and working with standards is all about its fit within workflows.