Standardizing healthcare practices: Experimental interventions in medicine and science and technology studies

This thesis discusses and relates two particular questions. The first more empirical question deals with innovative ways of organizing hospital care. Through the analysis of a series of cases in which care trajectories were ‘redesigned’, the relations between standardization of healthcare practices and complexities in patient care are explored. This relationship has often been analyzed in rather binary terms. Either practice variation is seen as the problem and medical practice needs to be rigorously standardized to make it ‘evidence based’ or standards and evidence are the problem, violating complexities of healthcare practices and turning them into ‘assembly line medicine’. I show how both these approaches to the relation between standardization and complexities are problematic. Attempts to ‘rationalize’ medical practice on the basis of aggregate medical knowledge separate the standard and the care practices it is to become relevant for. This creates ‘implementation problems’ and often painful marginalizations of other forms of knowledge and practice. Critiques of standardization on the other hand tend to result in an awkward conservatism: they privilege a fascination for complexity over sensitivity for problems that follow from the way sociotechnical arrangements currently ‘work’. In addition, they tend to be extremely limited in perceiving how this practice could also ‘work’ differently. Both these approaches to studying complexities and standardization therefore fail to contribute to situated improvements in healthcare practices. These are nevertheless dearly needed to prevent substantial suffering for both patients and medical professionals.