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Making Quality Transparent: How Quantification is Implicated in Changing Norms for Governing Healthcare

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Der Transparenz-Imperativ

Abstract

In recent years, the notion of transparency has gained increased importance as a way to govern the performance of public organizations. In order to achieve transparency in the healthcare sector, quantified descriptions of quality have become embedded in processes of evaluation and audit which are intended to make hospitals and other healthcare organizations knowable to a wider public. This chapter uses a case study of German hospitals to explore the origins of quantification practices which have enacted doctrines of transparency in the field of healthcare. More specifically, it focuses the role of “routine data” in making the quality of care transparent. It shows how routine data becomes a taken for granted way of accounting for quality, and in the process, how specific notions of medical care that were once rather opaque and unclear to outsiders have been made into objects of management and intervention. The paper contributes to a broader field of transparency research by asking how practices of quantification and the norms of transparency become aligned with one another to form a legitimate form of healthcare governance. In analyzing the ambiguous relationship between co-evolving practices and norms, and the drivers behind their development, insights could be drawn which help us understand how seemingly indispensable principles of good governance and good organization are realized with unintended consequences.

This paper was possible thanks to funding provided by the Deutsche Forschungsgemeinschaft (DFG) (Project No. 627097) under the Open Research Area Scheme (Project Title: QUAD—Quantification, Administrative Capacity and Democracy). In addition, many thanks are due to Vincent August, Christian Huber, Fran Osrecki, and Tobias Scheytt for their insightful comments on earlier drafts of the paper.

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Notes

  1. 1.

    Sozialgesetzbuch (SGB): Fünftes Buch (V) – Gesetzliche Krankenversicherung – (Artikel 1 des Gesetzes v. 20. Dezember 1988, BGBl. I S. 2477), § 301 Krankenhäuser. https://www.gesetze-im-internet.de/sgb_5/__301.html. Accessed on 31 July 2019.

  2. 2.

    Gesetz über die Entgelte für voll- und teilstationäre Krankenhausleistungen (Krankenhausentgeltgesetz – KHEntgG), § 21 Übermittlung und Nutzung von Daten. https://www.gesetze-im-internet.de/khentgg/__21.html. Accessed on 31 July 2019.

  3. 3.

    Wissenschaftliche Dienste des deutschen Bundestages (2007).

  4. 4.

    IQTiG has recently opened a department for measuring patient experience and developing indicators from patient surveys. As of 2019, however, these measures only apply to one medical procedure and thus constitute a small part of quality assurance compared those indicators developed out of routine data.

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  1. Helmut-Schmidt-Universität, Hamburg, Deutschland

    Jacob Reilley

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  1. Humboldt-Universität zu Berlin, Berlin, Germany

    Vincent August

  2. Hochschule für Wirtschaft und Recht Berlin, Berlin, Germany

    Fran Osrecki

Appendix

Appendix

1.1 Interviews cited (conducted between January 2017 and July 2017)

  • IP 01: Professor of Health Economics, former representative at National Institute for Quality and Patient Safety

  • IP 02: Representative, Scientific Institute for Quality Assurance at the AOK (WIdO)

  • IP 03: Head of quality assurance department, State Hospital Association

  • IP 04: Representative of the National Institute for Quality Assurance and Transparency (IQTiG)

  • IP 05: Representative of a state level quality assurance agency

  • IP 06: Professor of medicine and independent consultant for quality assurance

  • IP 07: Representative of the Scientific Institute for Quality Assurance at the AOK (WIdO)

  • IP 08: Head physician

1.2 Abbreviations for institutions and technical terminology

  • AOK—Statutory Health Insurance Fund (Allgemeine Ortskrankenkasse)

  • BQS—National Institute for Quality and Patient Safety (Bundesgeschäftsstelle für Qualität und Patientensicherheit)

  • DRG—Diagnosis Related Group (system for classifying hospital cases)

  • MDK—Medical Service of the Health Insurance Funds (Medizinischer Dienst der Krankenkassen)

  • InEK—National Institute for the Hospital Renumeration System (Institut für das Entgeltsystem im Krankenhaus)

  • IQTiG—National Institute for Quality Assurance and Transparency (Institut für Qualität und Transparenz im Gesundheitswesen)

  • QSR—Quality assurance with routine data-WIdO research project (Qualitätssicherung mit Routinedaten)

  • WIdO—Scientific Institute for Quality Assurance at the AOK (Wissenschaftliches Institut der AOK)

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Reilley, J. (2019). Making Quality Transparent: How Quantification is Implicated in Changing Norms for Governing Healthcare. In: August, V., Osrecki, F. (eds) Der Transparenz-Imperativ. Springer VS, Wiesbaden. https://doi.org/10.1007/978-3-658-22294-9_8

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