Marlot Kuiper

316 Connective Routines Conclusion All things considered, the answer to the research question is that professional standards work if they are actively made to work. Standards work if connections already exist and are brought into existence, both in teams, in workflows and by way of workable artefacts. Professional standards are dynamic; both in terms of ideas, performances, and the artefacts that represent them. Standards require responsiveness, rather than ‘standardized responses.’ Working with standards requires on the spot decisions; they only work when professionals deal with multiple, sometimes conflicting demands, set priorities and tailor solutions. New professional standards not ‘automatically work’. This means that ‘hybridity’, a natural interweaving of an organisational logic with a professional logic, is no automatic outcome of a standard to improve performance and reduce mistakes, but an ongoing context-dependent process. When talking about routines on a daily basis, people easily state “That work is routine”. From this study I would conclude quite the opposite: “That routine is (hard) work.” Implications This thesis has implications for both theory and practice. An extensive discussion of the implications, in which also methodological implications are covered, can be found in chapter 8. First of all, this research contributes to current debates about the reconfiguration of professionalism. This thesis has shown that professionals are first and foremost ‘pragmatic operators’, more that helpless victims or strategic operators. Professionals pragmatically cope with complex and conflicting demands that manifest in their daily work. In making on the spot decisions, ‘what’s best for the patient’ is decisive in their consideration. This thesis herewith paints a modest picture of the ‘organising professional’. Despite their awareness of ‘organising’ and organisational issues, in daily practice, treating patients is at the core of most doctors’ work. There are tight schedules and severe time pressures, and professionals try to do what’s best for ‘their patients’. The results of this study suggest that this theorization of an ‘organising professional’ at most applies to a few self-considered frontrunners, who demonstrate a particular interest in optimizing organisational processes and see organising as ‘part of their job’. Secondly, this thesis contributes to routine theory. By adding the notion of connections, this thesis provides new insights into routine dynamics, interactions, and artefacts. Through this study conducted in a highly professionalized domain,