Healthcare quality and managerial accounting are typically understood to be separate and competing tasks, logics, and/or areas of expertise. In this paper, however, we describe the emergence of what we call an accountable quality: a view of healthcare quality as something that must be expressed through management accounting itself.
We show further how this blending of accounting and quality challenges traditional distinctions of healthcare workers in terms of professional jurisdiction, task and office. By outlining the contours of the idealized subject of an accountable quality, whom we call homo qualitus, we highlight how the demands of quality relate to healthcare workers as individuals willing or not to demonstrate their commitment to quality through their affect and enthusiasm, expressed through the language, commitment and willingness to adopt, work with, and discuss what are essentially a variety of accounting devices.
This represents a significant change in accounting. In healthcare, accounting has tended to be used and valued as a means to calculate the cost, value, and performance of healthcare providers, doctors, etc. In relation to quality, however, accounting becomes a measure of an individual’s willingness, enthusiasm, and commitment to quality. Accounting, then, is less a means of undertaking calculating than a display of one’s willingness and enthusiasm toward quality, which becomes a proxy for quality of care itself.
The inability to measure and manage quality formally has long been seen as a significant barrier to improvement. Despite its incomplete realization, an accountable quality offers the possibility to overcome this barrier. This potential, we propose, is what encourages further commitment and investment. We show that what is likely to emerge from this investment is not to be the true and hidden knowledge about quality that is promised. Instead, it may be a new managerial infrastructure that in engaging all healthcare workers (nurses, doctors and administrators) removes quality still further from view.
You can find our paper at: https://doi.org/10.1080/09638180.2022.2035789 .
