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

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.