Reflexive Standardization and Standardized Reflexivity: Development and use of innovations in healthcare practices

Healthcare is inevitably confronted by many kinds of variation. For example, patients have multiple conditions and wish specific treatment, influencing their care trajectory as this results in different options for treatment or diagnosis (Eddy, 1984). Or different cultural backgrounds between the elderly admitted to nursing homes and their care givers result in communication differences (The, 2008). Or ranking hospitals to gain insight into the best shows substantial variation, depend-ing on who decides the order, the ranking criteria and the publisher, such as the Dutch opinion weekly Elsevier and the newspaper AD (Bal, 2014; Dijkstra & Harverkamp, 2012). Variation is found on all levels of healthcare and, as with the graffiti ex-ample, not all of it is either good or bad. Two dominant developments in healthcare, aimed at improving quality, seem on first sight to ‘stand for’ either good or unwanted variation. The first, the standardization movement seems mainly aimed at reducing unwanted variation, while the second, patient-centred care seeks to allow more individualized care and is likely to be associated with endorsing good variation. As I intend to show in this thesis, labelling variation as good or unwanted depends upon who perceives it in a particular context. The two developments of standardization and patient-centred care do not a priori resemble either ‘unwanted’ or ‘good’ variation. In the rest of this section I will explain this proposition