From local concerns to national solutions: The emergence of a national healthcare quality assessment system in Austria
Accounting and Management Control
Speaker: Silvia Jordan (University of Innsbruck)
In this paper, we study the emergence of a system of outcome quality assessment for hospitals in Austria, the Austrian Inpatient Quality Indicators (A-IQI). We trace the development of the A-IQI system since early mentions of healthcare quality in relevant laws in the mid-1990s until 2019. Our analysis illustrates how an accounting technology that was initially developed and employed as a means to criticize established power relations and practices in the governance of and the healthcare provision within hospitals came to be practiced primarily as a tool of symbolic account giving, largely bracketed from healthcare practitioners’ and patients’ everyday concerns and interactions. We illustrate how the technology that initially engaged lively debates, stirred up emotions and led to resistance of various actor groups, lost its engaging character, and became largely insignificant to healthcare practitioners, administrators, and patients when the national government implemented its nation-wide and compulsory use as a hospital performance measurement system. We employ the sociology of translation in order to trace how this transformation happened through the changing representational forms of the technology and the varying ways in which different actors came to construct the problems and interests associated with the technology.