Marlot Kuiper

311 control. Standardization then becomes part of an ‘organisational logic’ with values like objectivity, efficiency and measurability, that is at odds with a ‘professional logic’ with values like autonomy, altruism, and empathy. Standards can then even become ‘dangerous’, as they transformmedical practice into ‘cookbook medicine’. Hence, professionals will resist and/or manipulate standards to protect their position. A more contemporary perspective does no longer see organisations and professions as dichotomous. From the perspective of hybrid or organised professionalism, the introduction of new professional standards is seen as organised response to new challenges, in which organisations and professions are no longer inherently opposed to each other, but in which organising becomes a natural part of professional practices. Standards are then not seen as ‘danger’ or strategic instrument to protect the professional position, but as a way to deal with new service realities. In short, the relation between standards and professionals is disputed. Multiple perspectives exist, and we should study ‘how it really works’. The micro- perspective in particular requires further attention; how so-called ‘frontline professionals’ work with standards in their daily work. By combining various theoretical perspectives (that are extensively discussed in chapter 2 ) with empirical investigation, this thesis contributes to current debates on the ‘reconfiguration of professionalism’. The central research question is: “How and why do professional standards work in performance-oriented medical practices?” The research question is answered by means of a study in surgical care. This domain was chosen, firstly, because surgical professionalism is considered as ‘archetypical’ classic professionalism with firmly embedded professional values, and secondly, because the medical field can be considered the precursor in standardization. The complexity of medical conditions has significantly increased in this environment, and standards are employed to deal with such complexity. Besides, external forces like the news media pressure towards far-reaching standardization and accountability. Hence, the effects of standardization on professional practice will become highly visible. This study focuses on a surgical safety checklist, that requires confirmation of important checks like patient identity, intervention, and surgical side during