Marlot Kuiper

55 Standardization in professional settings standardization’; the aim of this conference was to set a standard for standards (Shiffman et al., 2003) So far, I have discussed the far-reaching tendency to standardize professional medical work, resulting in many guidelines, protocols, checklists, and ultimately; meta-standardization. Some scholars even speak of a proliferation of standards (cf. Rycroft ‐ Malone et al. 2008; Parker & Lawton, 2000). Though the term ‘standard’ is widely used, and generally associated with values like objectivity, rationality and uniformity (Timmermans & Almeling, 2009; Timmermans & Berg, 2003; Zuiderent-Jerak, 2007), it remains disputed if and how they can be personalized at the same time. On top of that, definitions of standards and standardization differ, and different concepts are often used interchangeably. Despite it could generally be argued that standards ‘aim to improve quality of health care delivery’ there is a wide divergence in what they aim to standardize and the means to accomplish this. ‘Standard’ can thus mean various different things. Therefore, some conceptual clarification and downsizing is needed. 2.3.1 A taxonomy of standards Evidence Based Medicine is just one example of how standardization is introduced in healthcare, and even EBM is not a uniform concept referring to one and the same thing. As Timmermans and Berg (2003, p.24) argue; “Standards and standardization are broad terms, differently defined, covering many entities, even when confined to the medical context.” Many studies however, lack a clear definition and thus demarcation of the concept and scholars quickly go over to a discussion of the effects of standardization. First of all, there seems to be a difference in the neutrality of the definitions provided. Timmermans and Berg (2003:24) for example refer to standardization as the process of “rendering things uniform”. In this definition, standards are considered “the outcome” of such processes. Bowker and Star (1999) offer a definition that resembles this neutral description of uniformity. They state that standardization is “a process of constructing uniformities across time and space, through the generation of agreed upon rules”. Where in this notion of standards the basic thought is “agreed upon rules”, Brunsson and Jacobsson (2002, p. 2) include firm claims of power in their definition of standards. According to them, standards constitute “rules about that those who adopt them should do”. With emphasizing power relations, it is thus argued that standardization enables ‘control at a distance’ (see also Yates (1989)). Although I do acknowledge that standards are ‘deeply political’ since they transform the ways people work 2