Commensuration of health-care quality standards through hospital accreditation: from measurement weapon to management tool?

The purpose of this study is to examine the management perceptions towards calculative practices behind the reconstruction of a mandatory hospital accreditation (HA) system that transforms multiple facets of health-care quality into a single performance index.

This study contributes to the sociology of quantification mobilising the concept of commensuration as a social process to reflect on contemporary changes in managing HA systems. Data are collected adopting a case study of a Spanish public hospital drawing on semi-structured interviews, observation and documentary review.

Findings emphasise a shift from standards’ compliance to a more comprehensive view encouraging continuous quality improvement. Accreditation acts as a tin opener to facilitate external inspection removing contextual differences amongst hospitals and reducing organisational practices into controllable objects. It also reveals underlying ethical concerns as the system was built as a care quality measure that promptly developed into an attainment goal.

The valuable role of HA to enhance quality standards and the limitations resulting from its commensuration practices will be of interest to policymakers, organisational managers and researchers.

Despite a growing emphasis on audit and valuation practices in health care, accounting studies examining the capacity of public hospitals to manage quality improvement are scarce. This study inspires further research on accreditation to overcome commensuration flaws regarding external transparency, evaluation ambiguity and extra incentives.

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This paper is published in the Journal of Accounting & Organizational Change

Authors: Miguel Vega, Joao Vieira da Cunha