Paper short abstract:

Inquiry reports into healthcare ‘scandals’ repeatedly point to culture as a cause of healthcare failures. I examine how such reports aim to make culture visible and accountable and reflect on the forms of accountability they enact; transformative, conservative, individualising, and collectivising.

Paper long abstract:

In the UK, healthcare 'scandals' and subsequent inquiries repeatedly point to the pivotal role culture plays in producing and sustaining healthcare failures. Most notably, the Francis report (2013), which documents the failings at Mid-Staffordshire Trust said to have contributed to the deaths of hundreds of patients between 2005 and 2009, was overwhelming a comment on the culture that existed at the hospital. Mid-Staffordshire Trust was characterised as having an 'insidious negative culture involving a tolerance of poor standards' and a culture of fear, secrecy and bullying (2013: 10).

More recently, the Kirkup Report (2015), which documents the failings in maternity care at Furness General Hospital, provides a stark illustration of how uncompromising working relationships between different professional groups, unwillingness to question taken-for-granted practices, denial of deficits in care, and zealous pursuit of professional ideology can combine to produce an organisational culture so dysfunctional as to culminate in the deaths of eleven babies and one mother. The Kirkup report echoes the denial, lack of candour and culture of secrecy found at Mid-Staffordshire Trust.

This paper explores enactments of accountability in the Kirkup report; how it seeks to make culture visible and accountable. I question what it means to make culture accountable and examine the tension between individual and collective incarnations of accountability. I position inquiry reports as a prominent new sociotechnology of accountability and reflect on the forms of accountability they enact; how they are transformative, conservative, individualising, and collectivising.