thesis
Standardizing healthcare practices: Experimental interventions in medicine and science and technology studies
- Publication date
- 25 October 2007
- Publisher
- 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.