Marlot Kuiper

317 the social mechanisms that mediate ostensive aspects and performances, become highly visible. This thesis herewith shows how variation on the ostensive dimension translates into collective behaviour. Where studies on the connections between routines predominantly focus on conflicting goals, this study mostly shows conflicts in the organisation of workflows. Lastly, this dissertation illustrates artefacts as political instruments, that can reconfigure social connections. This all happens within ‘real life’ contexts. Despite this dissertation makes only limited use of implementation theory, it makes a plea for more context sensitivity in implementation studies. Whereas studies in implementation science aim to unravel ‘factors’, this thesis underlines the importance and value of contextualizing. Finally, this thesis has some implications for professional practice. Professionals themselves might reflect on their own role and social patterns, and take a more active role in policy making. Further, there are some implications for other relevant stakeholders, such as hospital boards, accreditation organisations and inspectorates. ‘Watch’ and ‘conversate’ are key components in the recommendations to them. This study conducted in surgical care also has implications for other domains where standardization manifests itself. This thesis has convincingly shown that standardization of professional practice should never aim for rigidity. Standardization might be helpful in reducing complexity and accounting for professional practices, but to do justice to the demanding and unpredictable nature of professional work, standardization should always leave room for responsiveness.