Accounting for quality: on the relationship between accounting and quality improvement in healthcare

BMC Health Services Research

Dane Pflueger¹ 

[1] Department of Operations Management, Copenhagen Business School, Solbjerg Plads 3, Frederiksberg, 2000, Denmark

关键词: Patient survey;    Measurement;    Accounting;    Quality improvement;    Quality;   

Others  :  1174774
DOI  :  10.1186/s12913-015-0769-4

 received in 2014-07-23, accepted in 2015-02-27,  发布年份 2015

【 摘 要 】

Background

Accounting-that is, standardized measurement, public reporting, performance evaluation and managerial control-is commonly seen to provide the core infrastructure for quality improvement in healthcare. Yet, accounting successfully for quality has been a problematic endeavor, often producing dysfunctional effects. This has raised questions about the appropriate role for accounting in achieving quality improvement. This paper contributes to this debate by contrasting the specific way in which accounting is understood and operationalized for quality improvement in the UK National Health Service (NHS) with findings from the broadly defined ‘social studies of accounting’ literature and illustrative examples.

Discussion

This paper highlights three significant differences between the way that accounting is understood to operate in the dominant health policy discourse and recent healthcare reforms, and in the social studies of accounting literature. It shows that accounting does not just find things out, but makes them up. It shows that accounting is not simply a matter of substance, but of style. And it shows that accounting does not just facilitate, but displaces, control.

Summary

The illumination of these differences in the way that accounting is conceptualized helps to diagnose why accounting interventions often fail to produce the quality improvements that were envisioned. This paper concludes that accounting is not necessarily incompatible with the ambition of quality improvement, but that it would need to be understood and operationalized in new ways in order to contribute to this end. Proposals for this new way of advancing accounting are discussed. They include the cultivation of overlapping and even conflicting measures of quality, the evaluation of accounting regimes in terms of what they do to practice, and the development of distinctively skeptical calculative cultures.

【 授权许可】

   
2015 Pflueger; licensee BioMed Central.

【 图 表 】

Figure 1.

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