Marlot Kuiper

47 Standardization in professional settings the same language and share the same knowledge and assumptions” (Rogers, 2003 as cited in Adler & Kwon, 2013, p. 939). Far-reaching specialization could ultimately lead to segmentation between the various professional groups. The cultural differences between groups can impede collaboration, since the different subcultures with their internalized norms, values, and diverging jargon, make the creation of mutual understandings problematic (Abbott, 1988; Hall, 2005; Lingard et al., 2004). Besides, as students learn the knowledge and skills of medical practice, they also recognize and internalize social divisions of power and authority in medical work (Abbott, 1988; Diefenbach & Sillince, 2011; Freidson, 2001). Institutionalized hierarchical structures within medical institutions might lead to both vertical and horizontal segmentation. Vertical divisions of hierarchy place medical doctors in a superior position to other medical workers, such as nurse anaesthetists and nurse practitioners. Timmons and Tanner (2004, 2005) for instance suggest that a crucial feature of a scrub nurse is to ‘keep the surgeon happy’, and to take on what they refer to as a ‘hostess role’. Such a hierarchy thus “concentrates power in the hands of a [few] while relying on the obedient service of a vast body of subordinate nonprofessional support staff’ (Wolf, 1996, p. 55). Medical doctors differentiate themselves frommedical supporting staff, on the basis of their responsibility for patient care. Horizontal segmentation concerns for example the more generalized versus the specialized disciplines (Witman, 2008), or the separation between ‘diagnostic’ (e.g. internal medicine) and ‘surgical’ occupations, or between ‘surgical’ and supportive (e.g. anaesthesiology) specialties. Lengthy socialization, thorough specialization and strong segmentation thus facilitate and ensure that young medical professionals grow into their specific professional subdomain with its own norms and values. 2.2.3 Developments in professional work and professionalism Increasingly, the archetypical model of ‘professionalism’, with its characteristics and ways of training, has come under pressure (Denis et al., 2015; Evetts, 2003b, 2009; Noordegraaf & Steijn, 2014). Brock, Powell, & Hinings (1999), Brock (2006) and Greenwood & Lachman (1996) all pointed to several external and environmental factors that have affected professional work, such as the deregulation of professional markets, financial constraints and cost pressures, complex care demands, technological change and changes in the demands of increasingly knowledgeable clients. 2