Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Debate

Accounting for quality: on the relationship between accounting and quality improvement in healthcare

Author: Dane Pflueger

Published in: BMC Health Services Research | Issue 1/2015

Login to get access

Abstract

Background

Accounting-that is, standardized measurement, public reporting, performance evaluation and managerial control-is commonly seen to provide the core infrastructure for quality improvement in healthcare. Yet, accounting successfully for quality has been a problematic endeavor, often producing dysfunctional effects. This has raised questions about the appropriate role for accounting in achieving quality improvement. This paper contributes to this debate by contrasting the specific way in which accounting is understood and operationalized for quality improvement in the UK National Health Service (NHS) with findings from the broadly defined ‘social studies of accounting’ literature and illustrative examples.

Discussion

This paper highlights three significant differences between the way that accounting is understood to operate in the dominant health policy discourse and recent healthcare reforms, and in the social studies of accounting literature. It shows that accounting does not just find things out, but makes them up. It shows that accounting is not simply a matter of substance, but of style. And it shows that accounting does not just facilitate, but displaces, control.

Summary

The illumination of these differences in the way that accounting is conceptualized helps to diagnose why accounting interventions often fail to produce the quality improvements that were envisioned. This paper concludes that accounting is not necessarily incompatible with the ambition of quality improvement, but that it would need to be understood and operationalized in new ways in order to contribute to this end. Proposals for this new way of advancing accounting are discussed. They include the cultivation of overlapping and even conflicting measures of quality, the evaluation of accounting regimes in terms of what they do to practice, and the development of distinctively skeptical calculative cultures.
Literature
1.
Panzer R, Gitomer R, Greene W, Reagan Webster P, Landry K, Riccobano C. Increasing Demands for Quality Measurement. J Am Med Assoc. 2013;310(18):1971–80.CrossRef
2.
Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89(9):46–52.PubMed
3.
Shortell SM, Bennett CL, Byck GR. Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress. Milbank Q. 1998;76(4):593–624.PubMedPubMedCentralCrossRef
4.
Blomgren M, Sahlin K: Quest for Transparency Signs of a new institutional era in the health care field. In: Transcending New Public Management. edn. Edited by Christensen T, Lægrid P: Hampshire UK and Burlington VT: Ashgate; 2006.
5.
Berwick DM, James B, Coye MJ. Connections between quality measurement and improvement. Med Care. 2003;41(1):1–30.CrossRef
6.
Raleigh VS, Foot C: Getting the measure of quality. Opportunities and challenges. In. London: The King’s Fund; 2010.
7.
Epstein A. Performance measurement and professional improvement. In: Smith P, Mossoalos E, Papanicolas I, Leatherman S, editors. Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects. New York and Cambridge: Cambridge University Press; 2009. p. 613–40.
8.
Smith P, Mossoalos E, Papanicolas I, Leatherman S. Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects. New York and Cambridge: Cambridge Univ Press; 2009.
9.
Lohr KN. Rating the strength of scientific evidence: relevance for quality improvement programs. Int J Qual Health Care. 2004;16(1):9–18.PubMedCrossRef
10.
Lohr KM: Medicare: A Strategy for Quality Assurance, vol. 1. In. Washington, DC: National Academy Press; 1990.
11.
Shortell SM, Levin D, O’Brien J, Hughes E. Assessing the evidence on Continuous Quality Improvement: Is the glass half empry or half full? J Health Serv Admin. 1995;40:4–28.
12.
Blumenthal D, Epstein A. Quality of Health Care. Part 6: The role of the physician in the future of quality management. N Engl J Med. 1996;335:1328–31.PubMedCrossRef
13.
Øvretveit J, Gustafson D. Evaluation of quality improvement programmes. Quality Safety Health Care. 2002;11(3):270–5.CrossRef
14.
Sheldon TA. The healthcare quality measurement industry: time to slow the juggernaut? Quality Safety Health Care. 2005;14(1):3–4.CrossRef
15.
McGlynn EA. Six challenges in measuring the quality of health care. Health Aff. 1997;16(3):7–21.CrossRef
16.
Evans DB, Edejer T, Lauer J, Frenk J, Murray CJ. Measuring quality: from the system to the provider. Int J Qual Health Care. 2001;13(6):439–46.PubMedCrossRef
17.
Marshall MN, Shekelle PG, Leatherman S, Brook RH. Public disclosure of performance data: learning from the US experience. Quality Health Care. 2000;9(1):53–7.CrossRef
18.
Werner RM, Asch DA. The unintended consequences of publicly reporting quality information. JAMA. 2005;293(10):1239–44.PubMedCrossRef
19.
Schneider E, Lieberman T. Publicly disclosed information about the quality of health care: response of the US public. Quality Health Care. 2001;10(2):96–103.CrossRef
20.
Bevan G, Hood C. What’s measured is what matters: targets and gaming in the English public health care system. Public Adm. 2006;84(3):517–38.CrossRef
21.
Llewellyn S, Northcott D. The average hospital. Acc Organ Soc. 2005;30(6):555–83.CrossRef
22.
Freeman T. Using performance indicators to improve health care quality in the public sector: a review of the literature. Health Serv Manag Res. 2002;15:126–37.CrossRef
23.
Chassin MR, Loeb JM, Schmaltz SP, Wachter RM. Accountability measures—using measurement to promote quality improvement. New England J Med. 2010;363(7):683–8.CrossRef
24.
Audet A, Doty M, Shamasdin J, Schoenbaum S. Measure, learn, and improve: physicians’ involvement in quality improvement. Health Aff. 2005;24(3):843–53.CrossRef
25.
Loeb JM. The current state of performance measurement in health care. Int J Qual Health Care. 2004;12(Supplement 1):i5–9.CrossRef
26.
Falconer JA, Roth EJ, Sutin JA, Strasser DC, Chang RW. The critical path method in stroke rehabilitation: lessons from an experiment in cost containment and outcome improvement. Qual Rev Bull. 1993;19(1):8–16.
27.
Pellegrin KL, Carek D, Edwards J. Use of experimental and quasi-experimental methods for data-based decisions in QI. Joint Comm J Quality Improve. 1995;21(12):683–91.
28.
Pronovost P, Lilford R. A road map for improving the performance of performance measures. Health Aff. 2011;30(4):569–73.CrossRef
29.
Kilpatrick KE, Lohr KN, Leatherman S, Pink G, Buckel JM, Legarde C, et al. The insufficiency of evidence to establish the business case for quality. Int J Qual Health Care. 2005;17(4):347–55.PubMedCrossRef
30.
Braithwaite J, Wears RL: Resilient health care: Farnham UK: Ashgate; 2013
31.
Hollnagel E, Braithwaite J. Wears R (eds.): Resilient health care. Surrey, UK: Ashgate Publishing Limited; 2013.
32.
Boland Jr RJ. Beyond the objectivist and the subjectivist: learning to read accounting as text. Acc Organ Soc. 1989;14(5):591–604.CrossRef
33.
Pollitt C. The logics of performance management. Evaluation. 2013;19(4):346–63.CrossRef
34.
Pollitt C, Harrison S, Dowswell G, Jerak-Zuiderent S, Bal R. Performance regimes in health care: institutions, critical junctures and the logic of escalation in England and the Netherlands. Evaluation. 2010;16(1):13–29.CrossRef
35.
Donabedian A. The quality of care: How can it be assessed? J Am Med Assoc. 1988;260(12):1743–8.CrossRef
36.
Donaldson MS (ed.): Measuring the quality of health care. Washington DC: National Academies Press; 1999.
37.
Chassin MR, Galvin RW. The urgent need to improve health care quality: Institute of Medicine National Roundtable on Health Care Quality. J Am Med Assoc. 1998;280(11):1000–5.CrossRef
38.
39.
Berwick DM. Continuous quality improvement as an ideal in health care. New England J Med. 1989;320(1):53–6.CrossRef
40.
Berwick DM. Continuous Quality Improvement in Medicine: From Theory to Practice: Heal thyself or heal thy system: can doctors help to improve medical care? Quality Health Care. 1992;1(Supplement):2.CrossRef
41.
McLaughlin CP. Continuous quality improvement in health care: theory, implementation, and applications. Sudbury, MA: Jones & Bartlett Learning; 2004.
42.
43.
Sequist T, Bates D. Developing information technology capacity for performance measurement. In: Smith P, Mossoalos E, Papanicolas I, Leatherman S, editors. Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects. New York and Cambridge: Cambuidge University Press; 2009. p. 552–82.
44.
Edgman-Levitan S, Daley J, Delbanco TL. Through the patient’s eyes: understanding and promoting patient-centered care. San Francisco: Jossey-Bass; 1993.
45.
Veillard J, Garcia-Armesto S, Kadandele S, Lkazinga N. nternational health system comparisons: from measurement challenge to management tool. In: Smith P, Mossoalos E, Papanicolas I, Leatherman S, editors. Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects. New York and Cambridge: Cambridge Univ Press; 2009. p. 641–73.
46.
Timmermans S, Mauck A. The promises and pitfalls of evidence-based medicine. Health Aff. 2005;24(1):18–28.CrossRef
47.
Harrington L, Pigman H. e. ie: Quality measurement. In: Varkey P, editor. Medical quality management: theory and practice. Sudbury, MA: Jones and Bartlett Learning; 2009.
48.
World Health Organization: Quality of Care: A process for making strategic choices in health systems. In. Gneva: WHO Library; 2006.
49.
50.
Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Aff. 2005;24(1):138–50.CrossRef
51.
Darzi A: High Quality Care for All: Our Journey So Far. In. London: TSO; 2009.
52.
Mannion R, Davies H, Marshall M. Impact of star performance ratings in English acute hospital trusts. J Health Serv Res Policy. 2005;10(1):18–24.PubMedCrossRef
53.
Mennicken A, Vollmer H. A. P: Tracking the Numbers: Across Accounting and Finance, Organizations and Markets. Acc Organ Soc. 2009;34(5):619–37.CrossRef
54.
Miller P, Power M. Accounting, Organizing and Economizing: Connecting accounting research and organization theory. Acad Manag Ann. 2013;7(1):555–603.CrossRef
55.
Miller P, Hopwood A. Accoutning as Social and Institutional Practice. Cambridge: Cambridge Univ Press; 1994.
56.
Chapman C, Cooper D, Miller P. Linking accounting, organizations, and institutions. Acc Organ Soc. 2009;1(1):1–29.
57.
Burchell S, Clubb C, Hopwood A, Hughes J, Nahapiet J. The roles of accounting in organizations and society. Acc Organ Soc. 1980;5(1):5–27.CrossRef
58.
Hopwood A. Towards an organisational perspective for the study of accounting and information systems. Acc Organ Soc. 1978;3(1):3–13.CrossRef
59.
Miller P. Introduction. In: Miller P, Hopwood A, editors. Accoutning as Social and Institutional Practice. Cambridge, MA: Cambridge University Press; 1994.
60.
Hines R. Financial accounting: in communicating reality, we construct reality. Acc Organ Soc. 1988;13(3):251–61.CrossRef
61.
Hopwood A. The archeology of accounting systems. Acc Organ Soc. 1987;12(3):207–34.CrossRef
62.
Porter T: Trust in numbers: The pursuit of objectivity in science and public life: Princeton MA: Princeton University Press; 1996.
63.
Samiolo R. Commensuration and styles of reasoning: Venice, cost–benefit, and the defence of place. Acc Organ Soc. 2012;37(6):382–402.CrossRef
64.
Power M. The Audit Implosion: Managing Risk from the Inside. In. London: Institute of Chartered Accountants in England and Wales; 1999.
65.
Power M. Organized uncertainty: Designing a world of risk management. Oxford: Oxford University Press; 2008.
66.
Hopwood A. G: Accounting calculation and the shifting sphere of the economic. European Account Review. 1992;1(1):125–43.CrossRef
67.
Morgan G. Accounting as reality construction: towards a new epistemology for accounting practice. Acc Organ Soc. 1988;13(5):477–85.CrossRef
68.
Chapman C, Cooper D. Miller P (eds.): Accounting, Organizations and Institutions: Essays inHhonor of Anthony Hopwood. Oxford: Oxford University Press; 2012.
69.
Miller P, O’Leary T. Accounting expertise and the politics of the product: Economic citizenship and modes of corporate governance. Acc Organ Soc. 1993;18(2):187–206.CrossRef
70.
Miller P, O’Leary T. Accounting, ‘Economic Citizenship’, and the Spatial Reordering of Manufacture. Acc Organ Soc. 1994;19(1):15–43.CrossRef
71.
Miller P, O’leary T. Accounting and the construction of the governable person. Acc Organ Soc. 1987;12(3):235–65.CrossRef
72.
Power M. The audit society: Rituals of verification. Oxford: Oxford University Press; 1999.CrossRef
73.
Espeland WN, Sauder M. Rankings and Reactivity: How Public Measures Recreate Social Worlds. Am J Sociol. 2007;113(1):1–40.CrossRef
74.
Hacking I. Representing and Intervening. Cambridge: Cambridge University Press; 1983.CrossRef
75.
Darzi A: Quality of Care for All. In. London: TSO; 2008.
76.
Office of Technology Assessment. The Quality of Medical Care: Information for consumers. In: Library of Congress (88–600537): US Congress. 1988.
77.
Scott R, Reuf M, Mendel P, Caronna C. Institutional change and healthcare organizations: from professional dominance to managed care. Chicago: University of Chicago Press; 2000.
78.
Menninger WW. Caring as Part of Health Care Quality. J Am Med Assoc. 1975;234(8):836–7.CrossRef
79.
Cleary PD, McNeil BJ: Patient satisfaction as an indicator of quality care. Inquiry 1988;25(1):25–36.
80.
Leblow J. Consumer Assessments of the Quality of Medical Care. Med Care. 1974;12(4):328–37.CrossRef
81.
Locker D, Dunt D: Theoretical and methodological issues in sociological studies of consumer satisfaction with medical care. Social Science and Medicine 1978, Part A: Medical Psychology and Medical Sociology(12):283–292.
82.
Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Evaluation Program plan. 1983;6(3):185–210.CrossRef
83.
Ware JE, Snyder MK, Wright WR, Davies AR. Defining and measuring patient satisfaction with medical care. Evaluation Program plan. 1983;6(3):247–63.CrossRef
84.
Meng YY, Jatulis DE, McDonald JP, Legorreta AP. Satisfaction with access to and quality of health care among Medicare enrollees in a health maintenance organization. West J Med. 1997;166(4):242.PubMedPubMedCentral
85.
Gold M, Wooldridge J. Surveying consumer satisfaction to assess managed-care quality: current practices. Health Care Financing Review. 1995;16(4):155.PubMedPubMedCentral
86.
Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients’ assessments of care in Medicaid managed care. Health Serv Res. 2003;38(3):789–808.PubMedPubMedCentralCrossRef
87.
Delnoij DM. Measuring patient experiences in Europe: what can we learn from the experiences in the USA and England? European J Public Health. 2009;19(4):354–6.CrossRef
88.
89.
Beryl Institute: Zeroing in on patient experience: Views and voices from the front line. In. Edited by Wolfe J: Bedford TX: Beryl Institute; 2010.
90.
Beryl Institute: A report on the Beryl Institute benchmarking study: The state of patient experience in American hospitals. In. Edited by Wolfe J: Bedford TX: Beryl Institute; 2011.
91.
Beryl Institute: The Chief Experience Officer: An emerging and critical role. In. Edited by Wolfe J. Bedford, TX: Beryl Institute; 2014.
92.
Knorr-Cetina K. Epistemic Cultures: How the Sciences Make Knowledge. Cambridge MA: Harvard University Press; 1999.
93.
Desrosières A. The politics of large numbers: A history of statistical reasoning. Cambridge MA: Harvard University Press; 2002.
94.
95.
96.
Jobe J, Mingay D. Cognition and survey measurement: History and overview. Appl Cogn Psychol. 1991;5:175–92.CrossRef
97.
Ellwood P. Outcomes management: A technology of patient experience. New England J Med. 1988;318(23):1549–56.CrossRef
98.
Mold A. Patient Groups and the Construction of the Patient-Consumer in Britain: An Historical Overview. J Social Policy. 2010;39(4):505–21.CrossRef
99.
Pflueger D. Accounting for quality: the emergence and significance of managing for quality in healthcare. In: PhD Thesis Online. London: London School of Economics and Political Science; 2013.
100.
Zuiderent-Jerak T, Strating M, Nieboer A, Bal R. Sociological refigurations of patient safety; ontologies of improvement and ‘acting with’quality collaboratives in healthcare. Soc Sci Med. 2009;69(12):1713–21.PubMedCrossRef
101.
Timmermans S, Berg M. The gold standard: The challenge of evidence-based medicine and standardization in health care: Philadelphia PA Temple University Press. 2003.
102.
Foot C, Raleigh V, Ross S, Tyscom T: How Do Quality Accounts Measure Up?: Findings from the First Year. In. London: The Kings Fund; 2011.
103.
Department of Health: Quality Accounts: 2011/12 audit guidance. DoH. London: TSO; 2012.
104.
Power M. The risk management of nothing. Acc Organ Soc. 2009;34(6):849–55.CrossRef
105.
Millo Y, MacKenzie D. The usefulness of inaccurate models: Towards an understanding of the emergence of financial risk management. Acc Organ Soc. 2009;34(5):638–53.CrossRef
106.
Nocera J. The Quantitative, Data-Based, Risk-Massaging Road to Riches. In. New York Times: New York Times Magazine; 2005.
107.
Taleb NN: The Black Swan:The Impact of the Highly Improbable Fragility: New York NY: Random House LLC; 2010.
108.
Mikes A. Risk management and calculative cultures. Manag Account Res. 2009;20(1):18–40.CrossRef
109.
Francis R: Final Report Of The Independent Inquiry Into Care Provided By Mid Staffordshire NHS Foundation Trust. In: The Mid Staffordshire NHS Foundation Trust Enquiry. London: TSO; 2013.
110.
Van de Bovenkamp H, de Mul M, Quartz J, Weggellar-Jansen J, Marie A, Bal R. Institutional layering in governing healthcare quality. Public Adm. 2014;92(1):208–23.CrossRef
111.
Leatherman S, Sutherland K: The quest for quality: refining the NHS reforms: London: Nuffield Trust; 2008.
112.
Benzer M: Quality of life and risk conceptions in UK healthcare regulation: towards a critical analysis: Centre for Analysis of Risk and Regulation, London School of Economics and Political Science; 2011.
113.
Hood C, Jones DK: Accident And Design: contemporary debates on risk management: Abingdon UK: Routledge; 2003.
Metadata
Title
Accounting for quality: on the relationship between accounting and quality improvement in healthcare
Author
Dane Pflueger
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0769-4

Other articles of this Issue 1/2015

BMC Health Services Research 1/2015 Go to the issue

Research article

Determinants of patient-reported experience of cancer services responsiveness

Research article

Thai health care provider knowledge of neonatal male circumcision in reducing transmission of HIV and other STIs

Research article

Illness and medical and other expenditures: observations from western and eastern China

Research article

Effectiveness of an intermediate care hospital on readmissions, mortality, activities of daily living and use of health care services among hospitalized adults aged 60 years and older—a controlled observational study

Research article

How personal and standardized coordination impact implementation of integrated care

Research article

User experiences with clinical social franchising: qualitative insights from providers and clients in Ghana and Kenya