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.”Various exogenous developments force professions to organize collaboration. New standards, like checklists, are introduced to reconfigure work and organize so-called ‘connective professionalism’. Despite serious efforts, it has proven difficult to incorporate these standards in daily practice. Different perspectives on the reconfiguration of professional work explain noncompliance. While implementation science employs a solely instrumental perspective, Sociology of Professions literature employs a broader social perspective mostly focusing on maintaining professional power. By combining Sociology of Professions and Routine Theory, this paper provides an analytical perspective that embraces possibilities for change of routines. A critical case in surgical care is used to empirically show how a checklist (re)creates professional routines. Our ethnographic data show that rather than the result of active professional resistance, differences between checklists and routines emerge from pragmatic coping with checklists amidst high-paced circumstances. Though deviating from the formal rule, these might be meaningful action patterns.