Making up the numbers: quality improvement as a policy device for hard times
(University of Manchester)
Adam Brisley (University of Bristol)
Paper short abstract:
Financialisation has reduced public management to the assembly and maintenance of financial narratives and numbers. This requires devices that can both coordinate and differentiate complex practices. We examine quality improvement projects as one such device for 'making up' numbers.
Paper long abstract:
Studies of financialisation at work have emphasised the importance of strategic narratives constructed between senior management and external financial actors to create optimistic projections of value creation (Froud et al, 2006). These narratives shape and are shaped by valuation practices in 'the market', while management must produce the numbers to corroborate past narratives. The question of how these narratives are performed at the micro level has received less attention (Cushen, 2013), particularly when the managers and financial actors concerned are public organisations and national states. As states are enrolled as intermediaries for private capital, so their relationship to public organisations more resembles that of shareholders to corporations. In turn accounting practices gain importance and the managerial function shifts from active 'stewardship' (Perry & Nölke, 2006) to the assembly and maintenance of accounting numbers. We examine the framing of this managerial function through the narrative of 'quality improvement' (QI), within a public health care organisation. The QI programme in question targeted a clinical syndrome called 'Acute Kidney Injury' (AKI). The programme was initiated by the introduction of an algorithm to identify possible cases of AKI. Introducing the algorithm and embedding the necessary organisational processes to support its safe and effective use demanded the quantification of complex, distributed practices. QI programmes mobilise project logics in order to assemble numbers and maintain narratives, illuminating a relationship between projects and projection. The technical rationality of projects renders neutral the political work of quantification, while the language of QI maintains commitment on the clinical frontlines.
Beyond market attachment: differentiating and explicating the role of 'policy devices' in organising economic matters