Paper short abstract:

Based on a study of quality indicator development and accountability in Danish health care, the paper discusses how institutionalized accountability relations lend themselves to experimentation, and how data works as both generative and inhibiting resources for organizational experimentation.

Paper long abstract:

Intuitively, the nature of public organizations is probably considered to be a bureaucratic rather than an experimental one. However, this paper presents a highly experimental approach taken by a Danish Region in the attempt to transform health care governance from a strong focus on productivity towards a more multifaceted and value-based governance paradigm. For a 2-year period nine hospital departments have been exempted from the national system of activity-based financing and accountability (the DRG-system), and asked to render themselves accountable in other ways via self-chosen indicators. What makes this experiment particularly interesting is the absence of any framework for what qualifies as indicators, as well as any clear idea about how exactly the experiment would be conducive to the new governance paradigm envisioned by the Region. We find this to be an interesting case for discussing organizational experimentation.

Based on interviews with the departments, we analyze how the overall governance-experiment was translated into local projects of improvement, and how the process of transforming local clinical data into externally assessable performance indicators generated ambiguity, surprise and reflection. The paper discusses how institutionalized accountability relations lends themselves to experimentation and, more generally, the role of data in experimental processes, including how data are anything but 'raw' and factual but both inhibiting and generative resources for experimentation. Finally, as researchers funded by the Region, we reflect on our own position in relation to the Regions' eagerness for advice and opinions about their experimental approach.