Knowing patients: The customer survey and the changing margins of accounting in healthcare


Accounting Organizations and Society

aout 2016, vol. 53, pp.17-33

Departments: Accounting & Management Control

Keywords: Survey Healthcare Accounting change Quality improvement Customer

This research investigates the changing “margins of accounting” (Miller, 1998) in the field of healthcare where, as in other fields, customer surveys have emerged as a means of accounting for customers and of holding professionals and organizations to account. Drawing upon methodological insights provided by genealogical studies of accounting and anthropological studies of “things,” this research addresses the activities and transformations that take place to move the survey from war to ward—from a means of learning about medical populations during and immediately after World War II to a means of accounting for the views of consumers and of holding providers accountable for their care. These movements are shown to entail the staging and stabilizing of “knowing patients” in both senses of the term: these are patients that are equipped and empowered as consumers with knowledge about quality and their care, and simultaneously stripped of their individualizing characteristics so as to be made knowable to organizations in terms that can be managed and improved. These findings speak to the limitations of accounting as it infiltrates fluid and personal spaces in order to represent people in modes other than financial and to reconstitute knowledge from below. Doing so is shown not just to limit the possibilities for customers to speak and to be heard, but to give rise to a particularly pernicious form of territorialization in which the subject and object of accounting knowledge become inextricably intertwined and indistinguishably blurred. This has implications for the promises and practices of accounting in a post-modern society and for the kinds of questions that researchers ask about its effects.