Paper long abstract:

Rankings and other performance measurement tools are currently discussed as means to improve transparency in health care leading to better and more efficient performance. Non-compliance with with data collection for performance measurement - such as non-registration or the conscious adaptation of data - is often described as an act of strategic manipulation for the sake of personal or organizational benefit. We argue that such non-compliance is necessary for innovation in health care.

In order to study non-compliance in the case of performance measurement we focus on data collection practices, drawing on data from 6 months of ethnographic work in two Dutch hospitals. We make use of the Gandhian notion of creative dissent, which is increasingly considered amongst STS scholars. Creative dissent, as a method, combines resistance to or non-compliance with a particular (societal) condition, technology or mainstream policy with elements of creative and innovative work. We show that by means of creative forms of non-compliance professionals a) skilfully align dissimilar tasks in an environment of competing demands, b) generate situated and safe working practices, and c) contribute to organizational sensemaking. Creative non-compliance with performance measurement tasks, then, is not necessarily something negative but a resource for organizational development. Creative dissent, we also argue, enables the researcher to study the relevance of non-compliance for innovation.