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On 28 oktober 2020, 12.45 hrs. Marlot Kuiper MSc will defend her PhD thesis Connective Routines. An Ethnographic Analysis of how Professional Standards Work in Medical Practice.

This dissertation analyses if and how standardization is a means to reduce mistakes and to improve the quality of surgical care delivery. This is highly relevant, given the challenges of present-day professional service delivery: the delivery of (surgical) care is complex, quality expectations have risen, medical professionals cannot make mistakes, trust in medical professions is no longer guaranteed. 

New professional standards such as checklists are implemented as simple solutions to cope with these challenges. Checklists prescribe how professionals should work, for example with regard to safety during the operation process. Such procedural standards are praised for their simplicity, but practice is more unruly. Checklists do not automatically become part of professional routines and that is more than just an 'implementation problem'. 

Connecting routines 

Kuiper makes it clear that there are all kinds of dynamic processes and existing routines to which new tools have to connect if they are to succeed. For an adequate description of medical practice, she conducted ethnographic research in two hospitals and concluded that checklists, for example, are not 'easy' to implement.  

 She describes three crucial connections for the effective introduction of new routines in medical practice: 
 

• The connections between the professionals involved are of great importance. For example, professionals may have different views on the purpose of the checklist. Is it about safety, for example, is it about making the team function better or is it about accountability? And how do checklists relate to existing consultation structures and the hierarchical relationships within a team? 
   
• The connections between work practices. Professionals are confronted with the implementation of multiple, sometimes conflicting standards, which means they have to set priorities and deliver tailor-made solutions. Insight into professional practice at the workfloor and the active involvement of professionals themselves in the implementation of new standards is crucial. Professionals could also be trained in 'responsiveness' so they can make the right decisions in concrete situations.
   
• The links between 'artefacts' of standards. Is the checklist on paper, on a poster or in a computer program and what are the consequences? The design of artefacts matters for the workability of checklists.  

Marlot Kuiper MSc is is assistant professor, consultant and PhD student at the Utrecht ľ¹Ï¸£ÀûÓ°ÊÓ School of Governance.