Marlot Kuiper

312 Connective Routines the operative process. Such checklists are known as ‘static sequential checklist’ as they require confirmation of checks by various actors in the team. Therefore, surgical safety checklists are not only associated with reducing mistakes, but also with improving ‘performance’ or improving teamwork and collaboration. Research perspective and design To study ‘how standards work’, a research perspective that does justice to professional practices within organisational structures is needed. The development of this research perspective is the subject of chapter 4 . Literature on routines offers vantage points to study howmedical teams work with standards on a daily basis. A relatively new perspective within routine theory approaches routines as “recognizable, repetitive patterns of interdependent action carried out by multiple actors.” This perspective sees a routine as a dynamic system, that consists of an ostensive dimension (the abstract guiding principle, ideas of what the routine is) and a performative dimension (the actual performances by specific people, at specific times, in specific places). Further, artefacts are the material aspects that enable or constrain elements of routines. A safety checklist for surgical teams can be seen as a professional routine. The ostensive dimension consists of the ideas that participants have about the checklist; What is it? How should it be used? What is its purpose and value? These abstract ideas steer actual performances; how surgical teams work with the checklist. The ostensive and performative dimension influence each other. Artefactual representations like posters, the checklist on paper, or the checklist embedded in the software system aim to model the routine. From this perspective, a surgical safety checklist is seen as a dynamic system, that changes through its recurrent enactment. The way in which surgical teams recurrently perform the checklist, influences how this pattern (gradually) changes over time. From here flows the idea that a new standard (embedded in an artefact) not automatically results in the envisioned behaviour. By combining insights on organisational routines with ideas from the sociology of professions and science and technology studies, chapter 3 presents a theory-informed perspective that allows for a micro-level study of standards, with a focus on team behaviour and interactions. Three types of connections are central to the developed research perspective, as reflected in the title of this dissertation, ‘Connective Routines’. Firstly, social connections are crucial; connections between people. This thesis holds the