Connective Routines: How Medical Professionals Work with Safety Checklists

Abstract

New standards like checklists are introduced to establish so-called "connective professionalism," but it is difficult to work with checklists in daily circumstances. Professionals might comply with standards, but they might also neglect or resist them. By linking the sociology of professions to routine theory, we develop a relational perspective on working with standards, which is sensitive to the actual usage of standards, not so much "by" but "in-between" professionals. We analysed whether and how checklists are part of daily professional routines. Our ethnographic data show that medical professionals pragmatically cope with checklists. They "tick boxes," but also use standards to improve case treatment, depending on the nature of cases, time pressure, and team composition. Connections between professionals not so much result from standards, but are a prerequisite for using standards. Professionals themselves rather than checklists establish collaboration, but checklists might be important devices for using "connective potential." Keywords: Professional work, surgery, standards, implementation, routines, copingThe past few decades, many scholars have emphasized that routines are crucial for how organizations accomplish their tasks (Cyert & March, 1963; Nelson & Winter, 1982). Routines are "recognizable, repetitive patterns of interdependent action carried out by multiple actors" that structure work and are a basic necessity to carry out complex work in organizations (Feldman, Pentland, D'Adderio, & Lazaric, 2016, p. 505;Feldman & Pentland, 2003;Novak et al., 2012). Routines were mostly associated with stability and inertia (Cyert & March, 1963; Nelson & Winter, 1982) but a more recent perspective in the literature explicitly focuses on routines as a source for coping with complexity and change (e.g., Becker et al., 2005, Feldman & Pentland, 2003Feldman et al., 2016;Parmigiani & Howard-Grenville, 2011).Building on this, studies paid explicit attention to how organizational routines are changed triggered by exogenous events (Nigam, Huising, & Golden, 2016). Fundamental transitions in the context of work, such as new governmental regulations, knowledge and technologies, client demands and budgetary restraint (for an overview see Noordegraaf, 2015;2016) explicitly affect work in professional service domains and urge professionals to adapt their ways of working.More specifically, the complex interplay of service pressures has made professional service delivery more multifaceted, and this calls for multi-professional action (Noordegraaf, 2011;2016 healthcare require cooperation between various professionals. They might come from different (sub)disciplines. Professionals need to find ways to organize collaboration and create new routines that are connective (Noordegraaf, 2016;Noordegraaf, Schneider, van Rensen, & Boselie, 2016;Noordegraaf, van der Steen, & van Twist 2014). Put differently, the "recognizable, repetitive patterns of interdependent action carried out by multiple actors" need to be reconfigu...

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