Marlot Kuiper

79 Research Perspective: Professional routines First of all, theories on professional work and standardization led to the identification of three main ostensive ideas. First, there might be ostensive ideas in which professionals consider checklists a threat, for example a threat to professional judgment, or a threat because of the possibilities for external control. These abstract patterns would direct to resistant performances. On the contrary, professionals might consider checklists a means to professionalise, innovate and secure their status as ‘legitimate’ professional. This idea directly links to the broader dominant discourse of ‘Evidence Based Practice’ as a mechanism to improve quality of care. From these ostensive ideas might flow performances in which standards are actually used by professionals. From insights on hybrid professionalism, one would hypothesize standards as inherent aspect of professional work, in which professionals actively and naturally organise workflows. Based on the literature on professional education and socialization, I derived hierarchy and power as possible mechanisms that might mediate between ostensive- and behavioural patterns, in which professionals with a high rank and status (like surgeons or anaesthesiologists) would have more possibilities to match performances with their ostensive ideas, than those lower in hierarchy (like scrub nurses or nurse anaesthetists). Chapter 5 empirically studies how ostensive and performative aspects of the Surgical Safety Checklist routine interact in daily practice. Next, for this study in surgical care, I expanded the conceptual model by explicitly adding other routines that constitute work in this domain. Based on theoretical insights, coordination and collaboration are identified as important but difficult tasks. Connections between routines are thus expected to not emerge self- evidently. The performance of the checklist routine is highly dependent on other routines and entails coordinating a series of connections with other routines. This probably means that the interaction with existing routines will affect internal dynamics of the new routine. Further, Sociology of Professions literature provides useful insights into how professionals are trained to work (together). Because of strong socialization processes within subdisciplines, the ‘appropriate ways of behaviour’, jargon and hierarchy patterns are institutionalized in the various routines and are therefore important to take into consideration when studying a new, envisioned checklist routine that aims for connections. It is expected that when in existing routines patterns of communication (e.g. hierarchical) are different from what is expected in a new routine (e.g. speak up), it will be difficult to create this new routine. The focus in chapter 6 is on how the envisioned checklist routine interacts with existing routines. 3