Samenvatting

Bureaucracy and ‘red tape’ are seen as a main annoyance in healthcare practice. ‘Rules’ like guidelines and performance indicators would withdraw professionals from their real work, that is, helping patients. However, rules may also improve quality of care if they foster high quality practices. In this research, we explore how healthcare rebels deal with rules in their everyday work: how rebels ignore, engender and bend rules to build new environments for doing good care. Drawing on ethnographic research in three hospitals in the Netherlands (2017-2018), we reveal how rebels build and care for clinical microsystems containing their own clinical unit and related contexts (e.g. pharmaceutical suppliers, ICT companies, primary care) to evoke alternative and situated practices of good care delivery – i.e. focusing on quality of life and person-centred care. Rebels enact mechanisms of decoupling and recoupling to disconnect rules that embark on good care in specific patient situations, and build new routines that foster good care. However, such caring practices are hard to generalize as they often occur ‘under the radar’ and hence remain hardly noticed to the outside world. We argue that through revising accounting processes, and paying more attention to narratives of good care, more convenient quality systems could be found.