Marlot Kuiper

34 Connective Routines In chapter 8, I will provide more detailed explanations about the cross- fertilization of theoretical contributions, as this thesis shows how different bodies of literature can inform and strengthen one another. Methodological contributions Secondly, by ethnographically studying professional standards in surgical care, this study makes some methodological contributions. Many studies on ‘patient safety’ and ‘implementation of standards’ have been conducted. However, research so far largely focused on quantifying and classifying compliance, mistakes and outcomes, rather than providing detailed understanding of the actual routines in operating theatres and the perceptions of those involved. Studies using ethnographic methods in operating theatres are scarce (see McDonald et al., (2005) for an insightful exception). I gained access to a field – medicine - that is referred to as ‘non-public space’. Operating theatres in particular, are labelled the ‘backrooms of medicine’ (Goffman, 1959; Pope, 2005). I feel fortunate that I have been able to access the ‘closed world’ of surgery to study daily practices. Moreover, the few studies using ethnographic methods that exist, mostly concentrate around big concepts like ‘safety culture’, that are – as self-confessedly stated by the authors, not unproblematic (McDonald et al., 2005). By studying specific, demarcated practices in an ethnographic study, I got to see the many processes and interactions that constitute professional work ‘from the inside out’, and provide rich contextualized narratives. In a time in which experimental designs have gained considerable attention in the field of Public Administration (Bouwman & Grimmelikhuijsen, 2016; Grimmelikhuijsen et al., 2017), this thesis underlines the sustained importance of ethnographic approaches in Public Administration. There is little ethnography in the study of Public Administration and Public Management (Rhodes, 2014). This is remarkable, since Public Administration strives to be an applied discipline that deals with practical problems (ibid). As Ybema, Yanow, Wels, & Kamsteeg (2009) state in the introduction of their book on organisational ethnography: “[There is] a gulf between the lived experience of organising and being organised by others, with its uncertainty and confusion, and the tidy, rather sanitized, texts on organisational behaviour” (Ybema et al., 2009, p.2) quoting Fineman, Sims and Gabriel (2005, p. ix). Here is where this book studying how standards work in a professional setting in an ethnographic tradition makes a contribution.