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A Calculative Infrastructure in the Making: The Emergence of a Multi-Layered Complex for Governing Healthcare

ISBN: 978-1-78769-558-0, eISBN: 978-1-78769-557-3

Publication date: 7 August 2019

Abstract

This study sets out to shed light on those infrastructures underlying the ubiquitous, yet contested nature of governing by numbers. Investigating the 30-year long emergence of Germany’s “external quality assurance system” for hospitals, the authors show how methods for quantifying quality align with broader institutional and ideational shifts to form a calculative infrastructure for governance. Our study focuses on three phases of infrastructural development wherein methods for calculating quality, institutions for coordinating data and reform ideals converge with one another. The authors argue that the succession of these phases represents a gradual layering process, whereby old ways of enacting quality governance are not replaced, but augmented by new sets of calculative practices, institutions and ideas. Thinking about infrastructures as multi-layered complexes allows us to explore how they construct possibilities for control, remain stable over time and transform the fields in which they are embedded. Rather than governance being enacted according to a singular goal or value, we see an infrastructure that is flexible enough to support multiple modalities of control, including selective intervention, quality-based competition and automatized budgeting. Infrastructural change, instead of revolving around crises in measurement, is shaped by incubation periods – times of relative calm when political actors, medical practitioners, mathematicians, and many others explore and reflect past experiences, rather than follow erratic reforms fads. Finally, analysing infrastructures as multi-layered constructs underlines how they produce multiple images of care quality, which not only shift existing power relations, but also change the ways we understand and make sense of public services.

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Acknowledgements

Acknowledgments

Funding underlying the research project behind this chapter has been provided by the Deutsche Forschungsgemeinschaft (DFG) (Project No. 627097) under the Open Research Area Scheme (Project Title: QUAD – Quantification, Administrative Capacity and Democracy). We would like to thank the collaborators in this project, particularly Arjen Boin, Alex Griffiths, Maarten Hillebrandt, Christian Huber, Michael Huber, Nathalie Iloga Balep, Daphne van Kleef, Andrea Mennicken, Fabian Muniesa and Peter Miller, for comments on an earlier version of the chapter. We would also like to thank the participants of the EGOS conference sub-stream “Thinking Infrastructures,” held in the summer of 2017 in Copenhagen, our colleagues from the Department of Management Accounting and Control at Helmut-Schmidt-University Hamburg as well as this edited volume’s editors for helping us develop our work.

Citation

Reilley, J. and Scheytt, T. (2019), "A Calculative Infrastructure in the Making: The Emergence of a Multi-Layered Complex for Governing Healthcare", Kornberger, M., Bowker, G.C., Elyachar, J., Mennicken, A., Miller, P., Nucho, J.R. and Pollock, N. (Ed.) Thinking Infrastructures (Research in the Sociology of Organizations, Vol. 62), Emerald Publishing Limited, Leeds, pp. 43-68. https://doi.org/10.1108/S0733-558X20190000062004

Publisher

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Emerald Publishing Limited