Marlot Kuiper

54 Connective Routines well-known and influential example of standardization is Frederik Taylor’s ‘scientific management’, in which fabric workers were trained to use standardized methods as to achieve optimal efficiency (Daft, 2006; Timmermans & Berg, 2003) Although Taylor’s ideas might be among the most criticised and might have lost their appeal over the years (Locke, 1982), similar ideas of standardized processes and uniformity – for example labelled ‘the Macdonaldization of society’ – are popular mechanisms in current-day society (Ritzer, 2000; Timmermans & Almeling, 2009; Van Loon, 2015; Waring & Bishop, 2013). In the context of healthcare, probably the most well-known association with standardization is the implementation of Evidence Based Medicine (EBM). EBM was introduced as “the conscious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Haynes, Sackett, Gray, Cook, & Guyatt, 1996, p. 71). Scientific evidence, for example gathered in controlled clinical trials, is backed in Clinical Practice Guidelines that assist clinicians in their decision making. In detailing on the definition, Haynes et al. (1996, p. 196) emphasize the words conscientious and judicious. “ Conscientious means that evidence is applied consistently to each patient for whom it is relevant” [emphasis added]. “Judicious use calls for the incorporation of clinical expertise that balances the risks and benefits of diagnostic tests and alternative treatments for each patient and takes into account his or her unique clinical circumstances, including baseline risk and comorbid conditions, and preferences.” Standardization was chosen as a strategy to implement EBM. Efforts to standardize clinical practice on the basis of scientific evidence are justified by a growing body of research that shows that “when patterns of care are widely divergent, clinical outcomes suffer and, as a result, safety may be comprised” (Rozich et al., 2004, p. 5). Standardization is seen as a means to limit the potential of medical mistakes which will result in safer health care systems. Nonetheless, standardized protocols easily go by on the uniqueness of cases. Those who decry Evidence Based Medicine as ‘cookbook medicine’ ignore the conscious and judicious part of the definition of EBM (Haynes et al., 1996). Still, an increasing amount of such guidelines is published. Ironically, the ever growing amount of scientific evidence – and thus guidelines - made that professionals got lost in what is ‘the best’ scientific evidence. The establishment of a Conference on Guideline Standardization illustrates the emergence of ‘meta-