Accepted Paper:

Ranking the 'Goods' of Care  


Roland Bal (Erasmus University Rotterdam)
Iris Wallenburg (Erasmus University Rotterdam)

Paper short abstract:

Hospital rankings have evoked calculable spaces of measuring performance. Valuation encapsulates both quantitative representation and qualitative evaluation of the numbers presented, revealing distributed ‘goods’ of care.

Paper long abstract:

Rankings have evoked new forms of organizational competition in the healthcare arena. They are believed to render organizational performance¬ -and hence, 'healthcare quality'- both accessible and comparable, contributing to a more transparent healthcare system. In the Netherlands, where this study is located, two annual rankings are in use. One is published in a daily newspaper (Algemeen Dagblad), the other in a weekly magazine (de Elsevier). Both are based on (slightly different) sets of performance indicators, measuring and listing quality of care - thus 'putting performance into numbers' (Asdal 2011). In this paper, we examine the metrics and quantifying infrastructures of hospital performance measurement. Drawing on the ontological turn in Science & Technology Studies (Mol 2002, Woolgar and Lezaun 2013), we seek to open up the "calculating selves and calculative spaces" (Miller 1994) of hospital rankings, and study how these infrastructures evoke distributed practices of 'good care'.

Empirically we build on ethnographic work in three hospitals in the Netherlands (Bal, Quartz et al. 2013). We study how these hospitals enact hospital rankings and examine how they quantify their practices of care and make sense of them, both with regard to their own performance and in competition with others. More particularly, we study the 'calculable spaces' of measuring performance in which calculating instruments (e.g. pain scoring instruments, complication registrations) are enacted and performance is valued and accounted for. Valuation, we will argue, encapsulates both quantitative representation and qualitative evaluation of the numbers presented. These different practices reveal distributed 'goods' of care.

Panel T045
New Collective Practices of Measurement, Monitoring and Evidence