Top

Published in:

2019 | OriginalPaper | Chapter

Making Quality Transparent: How Quantification is Implicated in Changing Norms for Governing Healthcare

Author : Jacob Reilley

Published in: Der Transparenz-Imperativ

Publisher: Springer Fachmedien Wiesbaden

Activate our intelligent search to find suitable subject content or patents.

search-config

AI-assisted search

Off

Abstract

In recent years, the notion of transparency has gained increased importance as a way to govern the performance of public organizations. In order to achieve transparency in the healthcare sector, quantified descriptions of quality have become embedded in processes of evaluation and audit which are intended to make hospitals and other healthcare organizations knowable to a wider public. This chapter uses a case study of German hospitals to explore the origins of quantification practices which have enacted doctrines of transparency in the field of healthcare. More specifically, it focuses the role of “routine data” in making the quality of care transparent. It shows how routine data becomes a taken for granted way of accounting for quality, and in the process, how specific notions of medical care that were once rather opaque and unclear to outsiders have been made into objects of management and intervention. The paper contributes to a broader field of transparency research by asking how practices of quantification and the norms of transparency become aligned with one another to form a legitimate form of healthcare governance. In analyzing the ambiguous relationship between co-evolving practices and norms, and the drivers behind their development, insights could be drawn which help us understand how seemingly indispensable principles of good governance and good organization are realized with unintended consequences.

Dont have a licence yet? Then find out more about our products and how to get one now:

Springer Professional "Wirtschaft+Technik"

Online-Abonnement

Mit Springer Professional "Wirtschaft+Technik" erhalten Sie Zugriff auf:

über 102.000 Bücher
über 537 Zeitschriften

aus folgenden Fachgebieten:

Automobil + Motoren
Bauwesen + Immobilien
Business IT + Informatik
Elektrotechnik + Elektronik
Energie + Nachhaltigkeit
Finance + Banking
Management + Führung
Marketing + Vertrieb
Maschinenbau + Werkstoffe
Versicherung + Risiko

Jetzt Wissensvorsprung sichern!

inform now

Springer Professional "Wirtschaft"

Online-Abonnement

Mit Springer Professional "Wirtschaft" erhalten Sie Zugriff auf:

über 67.000 Bücher
über 340 Zeitschriften

aus folgenden Fachgebieten:

Bauwesen + Immobilien
Business IT + Informatik
Finance + Banking
Management + Führung
Marketing + Vertrieb
Versicherung + Risiko

Jetzt Wissensvorsprung sichern!

inform now

previous chapter Policing and Anticipatory Transparency: On Digital Transformations, Proactive Governance and Logics of Temporality

next chapter Massenüberwachung als Politik: Transparenz, Privatheit und die Geburt der Kryptopolitik

Available only for authorised users

Sozialgesetzbuch (SGB): Fünftes Buch (V) – Gesetzliche Krankenversicherung – (Artikel 1 des Gesetzes v. 20. Dezember 1988, BGBl. I S. 2477), § 301 Krankenhäuser. https://www.gesetze-im-internet.de/sgb_5/__301.html. Accessed on 31 July 2019.

Gesetz über die Entgelte für voll- und teilstationäre Krankenhausleistungen (Krankenhausentgeltgesetz – KHEntgG), § 21 Übermittlung und Nutzung von Daten. https://www.gesetze-im-internet.de/khentgg/__21.html. Accessed on 31 July 2019.

Wissenschaftliche Dienste des deutschen Bundestages (2007).

IQTiG has recently opened a department for measuring patient experience and developing indicators from patient surveys. As of 2019, however, these measures only apply to one medical procedure and thus constitute a small part of quality assurance compared those indicators developed out of routine data.

Abernethy, M. A., Chua, W. F., Grafton, J., & Mahama, H. (2007). Accounting and control in health care. Behavioural, organisational, sociological and critical perspectives. In C. Chapman, A. G. Hopwood, & M. D. Shields (Eds.), Handbooks of management accounting research (pp. 805–829). Oxford: Oxford University Press.

Albu, O. B., & Flyverbom, M. (2016). Organizational transparency. Conceptualizations, conditions, and consequences. Business and Society. https://doi.org/10.1177/0007650316659851.CrossRef

August, V. (2018). Theorie und Praxis der Transparenz: Eine Zwischenbilanz. Berliner Blätter, 21(76), 129–156.

Beaussier, A.-L., Demeritt, D., Griffiths, A., & Rothstein, H. (2016). Accounting for failure. Risk-based regulation and the problems of ensuring healthcare quality in the NHS. Health, Risk & Society, 18(3–4), 205–224.CrossRef

Becker, A. (2014). Grenzen der Objektivität—Qualität von Qualitätsvergleichen. Das Krankenhaus, 106(10), 924–933.

Beer, D. (2016). Metric power. London: Palgrave MacMillan.CrossRef

Bevan, G. (2008). Changing paradigms of governance and regulation of quality of healthcare in england. Health, Risk & Society, 10(1), 85–101.CrossRef

Bevan, G., & Hood, C. (2004). Targets, inspections, and transparency. British Medical Journal, 328(13), 598.CrossRef

Bevan, G., & Hood, C. (2006). What’s measured is what matters. Targets and gaming in the English public health care system. Public Administration, 84(3), 517–538.CrossRef

Blomgren, M. (2007). The drive for transparency. Organizational field transformations in swedish healthcare. Public Administration, 85(1), 67–82.CrossRef

Blomgren, M., & Sahlin, K. (2007). Quest for transparency. Signs of a new institutional era in the health care field. In T. Christensen & P. Lægreid (Eds.), Transcending new public management. The transformation of public sector reform (pp. 155–177). Aldershot: Ashgate.

Bowerman, M., Raby, H., & Humphrey, C. (2000). In search of the audit society. Some evidence from health care, police and schools. International Journal of Auditing, 4(1), 71–100.CrossRef

Briers, M., & Chua, W. F. (2001). The role of actor-networks and boundary objects in management accounting change. A field study of an implementation of activity-based costing. Accounting, Organizations and Society, 26(3), 237–269.CrossRef

Brignall, S., & Modell, S. (2000). An institutional perspective on performance measurement and management in the ‘new public sector’. Management Accounting Research, 11(3), 281–306.CrossRef

Brunsson, N., Rasche, A., & Seidl, D. (2012). The dynamics of standardization. Three perspectives on standards in organization studies. Organization Studies, 33(5–6), 613–632.CrossRef

Bühler, M., & Heintz, B. (2017). Seen but not noticed. The role of comparisons in economic sociology. Economic Sociology: The European Electronic Newsletter, 18(3), 9–18.

Burchell, S., Clubb, C., Hopwood, A. G., & Hughes, J. (1980). The roles of accounting in organizations and society. Accounting, Organizations and Society, 5(1), 5–27.CrossRef

Busse, R., Nimptsch, U., & Mansky, T. (2009). Measuring, monitoring, and managing quality in Germany’s hospitals. Value in Health Care, 28(2), 294–304.

Chapman, C. S., Cooper, D. J., & Miller, P. B. (Eds.). (2009). Accounting, organizations, and institutions. Oxford: Oxford University Press.

Cohen, M. D., March, J. G., & Olsen, J. P. (1972). Garbage can model of organizational choice. Administrative Science Quarterly, 17(1), 1–25.CrossRef

Dent, M. (2003). Remodelling hospitals and health professions in Europe. Medicine, nursing and the state. Hampshire: Palgrave Macmillan.CrossRef

Dent, M., Howorth, C., Mueller, F., & Preuschoft, C. (2004). Architype transition in the german health service. The attempted modernization of hospitals in a North German state. Public Administration, 82(3), 727–742.CrossRef

Donabedian, A. (1980). Explorations in quality assessment and monitoring (vol. 1). Ann Arbor: Health Administration Press.

Donabedian, A. (1992). Quality assurance in healthcare. Consumers’ role. Quality in Health Care, 1(4), 247–251.CrossRef

Espeland, W. N., & Lom, S. E. (2015). Noticing numbers. How quantification changes what we see and what we don’t. In M. Kornberger, L. Justesen, A. K. Madsen, & J. Mouritsen (Eds.), Making things valuable (pp. 1–17). Oxford: Oxford University Press.

Espeland, W. N., & Sauder, M. (2016). Engines of anxiety. New York: Russel Sage Foundation.

Espeland, W. N., & Stevens, M. L. (1998). Commensuration as a social process. Annual Review of Sociology, 24, 313–343.CrossRef

Espeland, W. N., & Stevens, M. L. (2008). A sociology of quantification. European Journal of Sociology, 49(3), 401–436.CrossRef

Fligstein, N. (1998). The politics of quantification. Accounting, Organizations and Society, 23(3), 325–331.CrossRef

Fox, J. (2007). The uncertain relationship between transparency and accountability. Development in Practice, 17(4–5), 663–671.CrossRef

Gerlinger, T. (2009). Der Wandel der Interessenvermittlung in der Gesundheitspolitik. In U. Willems, T. Winter, & B. Rehder (Eds.), Interessensvermittlung in Politikfeldern. Vergleichende Befunde Der Verbände- und Policyforschung (pp. 33–51). Wiesbaden: VS Verlag.

Glouberman, S., & Mintzberg, H. (2001). Managing the care of health and the cure of disease. Part I: Differentiation. Health Care Management Review, 26(1), 56–69.CrossRef

Griffiths, A., Beaussier, A.-L., Demeritt, D., & Rothstein, H. (2017). Intelligent monitoring. Assessing the ability of the care quality commission’s statistical surveillance tool to predict quality and prioritise NHS Hospital inspections. The BMJ, 26(2), 120–130.

Grobe, T. G., Nimptsch, U., & Friedrich, J. (2014). Krankenhausbehandlung. In E. Swart, P. Ihle, H. Gothe, & D. Matusiewicz (Eds.), Routinedaten im Gesundheitswesen. Handbuch Sekundärdatenanalyse. Grundlagen, Methoden und Perspektiven (pp. 121–145). Bern: Huber.

Hacking, I. (2002). Historical ontology. Cambridge: Harvard University Press.CrossRef

Han, B.-C. (2012). Transparenzgesellschaft. Berlin: Matthes & Seitz.

Hansen, H. K. (2015). Numerical operations, transparency illusions and the datafication of governance. European Journal of Social Theory, 18(2), 203–220.CrossRef

Heald, D. (2006). Transparency as an instrumental value. In C. Hood & D. Heald (Eds.), Transparency. The key to better governance (pp. 59–74). Oxford: Oxford University Press.

Heintz, B. (2010). Numerische Differenz. Überlegungen zu einer Soziologie des (quantitativen) Vergleichs. Zeitschrift für Soziologie, 39(3), 162–181.CrossRef

Heller, G., & Günster, C. (2008). Mit Routinedaten Qualität in der Medizin sichern. Aktuelle Entwicklungen und weitere Perspektiven. Gesellschaft und Gesundheit Wissenschaft, 8(1), 26–34.

Heller, G., Swart, E., & Manksy, T. (2004). Qualitätsanalysen mit Routinedaten. Ansatz und erste Analysen aus dem Gemeinschaftsprojekt ‚Qualitätssicherung mit Routinedaten‘ (QSR). In J. Klauber, B. P. Robra, & H. Schnellschmidt (Eds.), Krankenhausreport 2003 (pp. 271–288). Stuttgart: Schattauer.

Hood, C. (1991). A public management for all seasons. Public Administration, 69(1), 3–19.CrossRef

Hood, C. (1995). The ‘new public management’ in the 1980s. Variations on a theme. Accounting, Organizations and Society, 20(2–3), 93–109.CrossRef

Hood, C. (2006). Gaming in targetworld. The targets approach to managing british public services. Public Administration Review, 66(4), 515–521.CrossRef

Hood, C. (2007). Public service management by numbers. Why does it vary. Where has it come from. What are the gaps and the puzzles. Public Money and Management, 27(2), 95–102.CrossRef

Hood, C. (2012). Public management by numbers as a performance-enhancing drug. Two hypotheses. Public Administration Review, 72(1), 85–92.CrossRef

Hood, C., & Heald, D. (Eds.). (2006). Transparency. The key to better governance. Oxford: Oxford University Press.

Hopwood, A. G. (1990). Accouting and organisation change. Accounting, Auditing & Accountability Journal, 3(1), 7–16.CrossRef

Jeschke, E., Heyde, K., & Günster, C. (2013). Der Zusammenhang von Komplikationen im Krankenhaus und im Follow-up und Implikationen für die Qualitätsmessung bei Hüftgelenksendoprothesen. Eine Analyse von AOK-Routinedaten. Gesundheitswesen, 75(5), 288–295.

Kingdon, J. W. (2003). Agendas, alternatives, and public policies. New York: Addison-Wesley Publishing Company.

Kopp, I. B. (2011). Von Leitlinien zur Qualitättssicherung. Bundesgesundheitsblatt, 54(2), 160–165.CrossRef

Kornberger, M., & Carter, C. (2010). Manufacturing competition. How accounting practices shape strategy making in cities. Accounting, Auditing & Accountability Journal, 23(3), 325–349.CrossRef

Kurunmäki, L. (1999). Professional vs. financial capital in the field of health care. Struggles for the redistribution of power and control. Accounting, Organizations and Society, 24(2), 95–124.CrossRef

Kurunmäki, L., & Miller, P. (2008). Counting the costs. The risks of regulating and accounting for health care provision. Health, Risk & Society, 10(1), 9–21.CrossRef

Kurunmäki, L., & Miller, P. (2013). Calculating failure. The making of a calculative infrastructure for forgiving and forecasting failure. Business History, 55(7), 1100–1118.CrossRef

Kurunmäki, L., Mennicken, A., & Miller, P. (2016). Quantifying, economising, and marketising. Democratising the social sphere. Sociologie Du Travail, 58(4), 390–402.CrossRef

Lapsley, I. (1996a). Health care reforms. Solutions or problems. Financial Accountability & Management, 12(2), 83–87.CrossRef

Lapsley, I. (1996b). Reflections on performance measurement in the public sector. In I. Lapsley & F. Mitchell (Eds.), Accounting and performance measurement. Issues in the private and public sectors (pp. 109–128). London: Paul Chapman Publishing Ltd.

Lapsley, I. (1999). Accounting and the new public management Instruments of substantive efficiency or a rationalising modernity. Financial Accountability and Management, 15(3–4), 201–207.CrossRef

Lapsley, I. (2016). New public management. The story continues. Financial Accountability & Management, 32(4), 385–408.CrossRef

Levay, C., & Waks, C. (2009). Professions and the pursuit of transparency in healthcare. Two cases of soft autonomy. Organization Studies, 30(2), 509–527.CrossRef

Llewellyn, S. (2001). Two-way windows. Clinicians as medical managers. Organization Studies, 22(4), 593–623.CrossRef

Llewellyn, S., & Northcott, D. (2005). The average hospital. Accounting, Organizations and Society, 30(4), 555–583.CrossRef

Mau, S. (2017). Das metrische Wir. Über die Quantifizierung des Sozialen. Berlin: Suhrkamp.

Merry, S. E. (2016). The seductions of quantification. Measuring human rights, gender violence, and sex trafficking. Chicago: The University of Chicago Press.CrossRef

Merry, S. E., & Coutin, S. B. (2014). Technologies of truth in the anthropology of conflict. American Ethnologist, 41(1), 1–16.CrossRef

Messer, M., & Reilley, J. T. (2015). Qualitätsberichte als Vermittlungsinstanz im Wettbewerb zwischen Krankenhäusern. Patienten als rationale Akteure. Berliner Journal für Soziologie, 25(1–2), 61–81.CrossRef

Miller, P. (1994). Accounting as social and institutional practice. An introduction. In A. G. Hopwood & P. Miller (Eds.), Accounting as social and institutional practice (pp. 1–39). Cambridge: Cambridge University Press.

Miller, P. (2001). Governing by numbers. Why calculative practices matter. Social Research, 68(2), 379–396.

Miller, P., & Power, M. (2013). Accounting, organizing, and economizing. Connecting accounting research and organization theory. The Academy of Management Annals, 7(1), 557–605.CrossRef

Miller, P., & Rose, N. (1990). Governing economic life. Economy and Society, 19(1), 1–31.CrossRef

Miller, P., & Rose, N. (2008). Governing the present Administering economic, social and personal life. Cambridge: Polity.

Modell, S. (2004). Performance measurement myths in the public sector. A research note. Financial Accountability & Management, 20(1), 39–55.CrossRef

Neyland, D., & Coopmans, C. (2014). Visual accountability. Sociological Review, 62(4), 1–23.CrossRef

Olsen, J. P. (2013). The institutional basis of democratic accountability. West European Politics, 36(3), 447–473.CrossRef

Palermo, T., Power, M., & Ashby, S. (2017). Navigating institutional complexity. The production of risk culture in the financial sector. Journal of Management Studies, 54(2), 154–181.CrossRef

Pflueger, D. (2015). Accounting for quality. On the relationship between accounting and quality improvement in healthcare. BMC Health Services Research, 15(1), 178–191.CrossRef

Pflueger, D. (2016). Knowing patients. The customer survey and the changing margins of accounting in healthcare. Accounting, Organizations and Society, 53(17), 17–33.CrossRef

Pollitt, C. (1990). Managerialism and the public services. The anglo-american experience. Oxford: Blackwell.

Pollitt, C. (1996). Business approaches to quality improvement. Why they are hard for the NHS to swallow. Quality in Health Care, 5(2), 104–110.CrossRef

Pollitt, C. (2005). Performance management in practice. A comparative study of executive agencies. Journal of Public Administration Research and Theory, 16(1), 25–44.CrossRef

Pollitt, C. (2007). Hospital performance indicators. How and why neighbours facing similar problems go different ways. Building explanations of hospital performance indicator systems in England and the Netherlands. In C. Pollitt, S. van Thiel, & V. Homburg (Eds.), New public management in Europe. Adaptation and alternatives (pp. 149–164). Hampshire: Palgrave Macmillan.

Pollitt, C. (2013). The logics of performance management. Evaluation, 19(4), 346–363.CrossRef

Pollitt, C. (2016). Managerialism redux. Financial Accountability & Management, 32(4), 429–447.CrossRef

Porter, T. M. (1995). Trust in numbers. The pursuit of objectivity in science and public life. Princeton: Princeton University Press.

Porter, T. M. (2015). The flight of the indicator. In R. Rottenburg, S. E. Merry, S.-J. Park, & J. Muggler (Eds.), The world of indicators. The making of governmental knowledge through quantification (pp. 34–55). Cambridge: Cambridge University Press.CrossRef

Porter, M. E., & Guth, C. (2012). Redefining german health care. Moving to a value-based system. Heidelberg: Springer.CrossRef

Power, M. (1997). The audit society. Rituals of verification. Oxford: Oxford University Press.

Power, M. (2004). Counting, control and calculation. Reflections on measuring and management. Human Relations, 57(6), 765–783.CrossRef

Power, M. (2007). Organized uncertainty. Designing a world of risk management. Oxford: Oxford University Press.

Power, M. (2015). How accounting begins. Object formation and the creation of infrastructure. Accounting, Organizations and Society, 47, 43–55.CrossRef

Reilley, J. T., & Scheytt, T. (2017). Governing through quantification. Developing a calculative infrastructure for controlling quality in german hospitals. Risk & Regulation, 33, 18–21.

Revellino, S., & Mouritsen, J. (2015). Accounting as an engine. The performativity of calculative practices and the dynamics of innovation. Management Accounting Research, 28, 31–49.CrossRef

Robson, K. (1992). Accounting numbers as ‘inscription’. Action at a distance and the development of accounting. Accounting, Organizations and Society, 17(7), 685–708.CrossRef

Rose, N., & Miller, P. (1992). Political power beyond the state. Problematics of government. The British Journal of Sociology, 43(2), 173–205.CrossRef

Sauder, M., & Espeland, W. N. (2009). The discipline of rankings. Tight coupling and organizational change. American Sociological Review, 74(1), 63–82.CrossRef

Schimank, U. (2005). ‘New public management’ and the academic profession. Reflections on the German situation. Minerva, 43(4), 361–376.CrossRef

Smith, P. (1995). On the unintended consequences of publishing performance data in the public sector. International Journal of Public Administration, 18(2–3), 277–310.CrossRef

Strathern, M. (2000). The tyranny of transparency. British Educational Journal, 26(3), 309–321.CrossRef

Timmermans, S. (2008). Professionals and their work. Do market shelters protect professional interests. Work and Occupations, 35(2), 164–188.CrossRef

Vogd, W., Feißt, M., Molzberger, K., Ostermann, A., & Slotta, J. (2018). Entscheidungsfindung im Krankenhausmanagement. Zwischen gesellschaftlichem Anspruch, ökonomischen Kalkülen und professionellen Rationalitäten. Wiesbaden: Springer VS.

Vollmer, H. (2007). How to do more with numbers. Elementary stakes, framing, keying, and the three-dimensional character of numerical signs. Accounting, Organizations and Society, 32(6), 577–600.CrossRef

Werron, T. (2014). On public forms of competition. Cultural Studies—Critical Methodologies, 14(1), 62–76.CrossRef

Wieczorek, C. C., Marent, B., Osrecki, F., Dorner, T. E., & Dür, W. (2015). Hospitals as professional organizations. Challenges for reorientation towards health promotion. Health Sociology Review, 24(2), 123–136.CrossRef

Wissenschaftliche Dienste des deutschen Bundestages. (2007). Qualitätssicherung und Transparenz im Rahmen der Gesundheitsreform unter besonderer Berücksichtigung des Datenschutzes.

Title: Making Quality Transparent: How Quantification is Implicated in Changing Norms for Governing Healthcare
Author: Jacob Reilley
Publisher: Springer Fachmedien Wiesbaden
Book: Der Transparenz-Imperativ
Print ISBN: 978-3-658-22293-2

Electronic ISBN: 978-3-658-22294-9

Copyright Year: 2019
DOI: https://doi.org/10.1007/978-3-658-22294-9_8