Marlot Kuiper

61 Standardization in professional settings First of all, there are accounts of professionalisation. In the 1990s clinicians and sociologists argued that through using standards the ‘recognizability’, ‘status’ and ‘self-esteem’ of professions would increase (e.g. Sachs, 2003; Woolf, Grol, Hutchinson, Eccles, & Grimshaw, 1999). Various authors felt that the explicit use of scientific evidence, backed in checklists, would be beneficial for the status of the profession (Eddy, 1992; Institute of Medicine (U.S.). Committee on Clinical Practice Guidelines, 1990). From this perspective, checklists are seen as tool to gain legitimacy and further professionalise. 2.4.3 Checklist as performance facilitator and/or indicator Yet, the same checklists that are argued to increase the status of the medical profession and considered a helpful tool in increasing the overall legitimacy and position of the professions, also make the care process more vulnerable to meddling by outsiders (Timmermans, 2005). Checklists, as sharply defined action patterns, are quickly seen as the ultimate bureaucratic instrument, prescribing what to do when and in what ways (Berg, Horstman, Plass, & Van Heusden, 2000). This is considered an assault on professional powers, for at least two reasons. Firstly, the standardization of medical work interferes with professional judgment. Professional autonomy enables workers to assess and evaluate cases and conditions and to make judgments regarding advice, performance, and treatment (Evetts, 2002). Checklists that prescribe how we should (re)configure professional work interfere with longstanding professional arrangements and is seen and felt as “intrusion” (Evetts, 2011; Kirkpatrick & Noordegraaf, 2015; Levay &Waks, 2009). Secondly, the performance of professionals and ‘outputs’ of their work are not easily standardized and measurable. This is why professionals consider themselves as the only actor capable of evaluating and controlling professional work (Freidson, 1970). The creation of checklists creates a window of opportunity to assess professional practice, as outsiders can monitor adherence to checklists and compare performance. 2.4.4 Checklist as organised response A fourth conceptualization stems from recent developments in theorizing ‘professionalism’. Authors felt a clear distinction between organisations and professions and their accompanying values was no longer feasible in describing current-day professionalism (Evetts, 2011; Gleeson & Knights, 2006; Noordegraaf, 2015, 2016). Rather than an assault on professionalism or a tool to reinforce professional legitimacy, standards are increasingly considered an 2