Quantified control in healthcare work: Suggestions for future research

• Date: 01 November 2020
• Published date: 01 November 2020
• Author: Johan Jönsson,Tony Huzzard,Charlotta Levay
• DOI: http://doi.org/10.1111/faam.12242

Received: 25 February2019 Revised: 21 January 2020 Accepted:26 January 2020

DOI: 10.1111/faam.12242

RESEARCH ARTICLE

Quantified control in healthcare work: Suggestions

for future research

Charlotta Levay Johan Jönsson Tony Huzzard

Department of Business Administration,Lund

University School of Economics and

Management, Lund, Sweden

Correspondence

CharlottaLevay, Department of Business Admin-

istration,Lund University School of Economics

andManagement, P.O.Box 7080, SE-220 07 Lund,

Sweden.

Email:charlotta.levay@fek.lu.se

Fundinginformation:

Forte,the Swedish Research Council for Health,

WorkingLife and Welfare, Grant Number: 2017-

01919;The Swedish Foundation for Humanities

andSocial Sciences, Grant Number: M14-0138:1

Abstract

This paper outlines promising avenues for empirical research on

quantified control in healthcare work. A review of key insights

from accounting, organization studies, and the emergent sociology

of quantification indicates that numbers are productive as well as

deceptive and seductive, that theyenable control but can be evaded,

and that they typically have unintended effects. It remains to be fur-

ther explored how multiple forms of measurement and quantified

control play out in everydayhealthcare work. Other questions worth

probing concern the limits and capabilities of numbers as a shared

language, the differential and disciplinary effects of numbers on

social groups, the use of numbers for impression management, and

how people manage to resist or mobilize numbers for different pur-

poses. Calling for additional qualitative, close-up studies, the paper

proposes a research focus on everydaypractices and the interactions

of diverse control measures. It sets out several fruitful methodolog-

ical pathways, both the well-established approaches of ethnography

and Actor-Network Theory and the more novel approaches of inves-

tigating numbers as communicative acts or as dramaturgical perfor-

mances.

KEYWORDS

calculative practice,control, ethnography, healthcare, quantification

“Andwhat do you do with five-hundred millions of stars?”

“Five-hundred-and-one million, six-hundred-twenty-two thousand, seven-hundred-thirty-one. I am concerned

with matters of consequence: I am accurate.”

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and repro-

duction in anymedium, provided the original work is properly cited.

c

2020 The Authors. Financial Accountability & Management published by John Wiley& Sons Ltd

Financial Acc & Man. 2020;36:461–478. wileyonlinelibrary.com/journal/faam 461

462 LEVAYET AL.

“Andwhat do you do with these stars?” [—]

“I administer them,” replied the businessman. “I count them and recountthem. It is difficult. But I am a man who

is naturally interestedin matters of consequence.”

The little prince was still not satisfied. [—]

“But you cannot pluck the stars from heaven …”

“No. But I can put them in the bank.”

“Whatever does that mean?”

“That means that I write the number of my stars on a little paper.And then I put this paper in a drawer and lock

it with a key.”

“Andthat is all?”

“That is enough,” said the businessman.

“It is entertaining,” thought the little prince. “It is rather poetic. But it is of no greatconsequence.”

Antoine de Saint-Exupéry,The Little Prince

1INTRODUCTION

Quantificationis central to the governing of contemporary society. Ever since the “avalancheof printed numbers” relat-

ingto population statistics in the early mid-19th century (Hacking, 1982), techniquesof notation and computation have

been essential in modern forms of expertise-basedrule (Miller & Rose, 1990). In the past three decades, there has been

a renewed avalanche of numbers in public life, with prominence givento performance numbers expressed in economic

or financial terms (Kurunmäki, Mennicken, & Miller, 2016). Accounting numbers are increasingly important, such as

the performance measures involvedin New Public Management reforms (Hood, Dixon, & Wilson, 2009; Lapsley, 2008,

2009). Today, we appear to livein a “metric society” where digitization and big data technologies enable ever mounting

data processing and practices of measurement, evaluation, and comparison (Mau, 2019).

Research in various fields including the sociology of quantification, critical accounting, and critical management

studies has demonstrated considerableproblems with these developments, especially as regards New Public Manage-

ment reforms and the intensified financial control of professional practice. There are consistent gaps between policy

and practice, recurrent unintended consequences, and series of quantified control devicesthat fail, only to be replaced

by new but similar instruments (Lapsley,2008; Northcott & Llewellyn, 2005; Power, 2004). Close-up, qualitative stud-

ies of specific organizational microprocesses havebeen particularly effective in uncovering problematic consequences

following grand reforms (e.g., Chua, 1995; Kurunmäki, 1999; Llewellyn & Northcott, 2005; Lowe, 2000; Wadmann,

Holm-Petersen, & Levay, 2019; Wallenburg, Quartz, & Bal, 2019). Still, as Kurunmäki et al. (2016) point out, instru-

ments to quantify performance are also integral to ambitions to hold officials to account and may be used for critical

debate and political activism. They even warn for phobic responses to numerical control and argue for a distinction

between quantification as such, which is not necessarily problematic, and the economizing and marketizing it is often

connected to.

In our view, the potential for meaningful, practice-relevant research on the role of numbers and quantified control

in organizations is far from exhausted.This is not because previous scholarship displays any particular knowledge gaps

but because it suggests intriguing aspects that deserve further study, a central one being that “numbers are power-

ful and fragile, simple and qualified, trusted and distrusted simultaneously” (Power, 2004, p. 779). In this paper, we

focus on quantified control in healthcare work and propose topics and approaches for future research. Healthcare is

an interesting area for investigatingthese issues. It is an arena of ideal–typical professionalism (Freidson, 1970), where

dynamics that may also be present in other professionalized human service fields, such as education or social care,

are particularly pronounced and accessible for study.It involves several kinds of quantification connected to different,

sometimes conflicting institutional logics, notably professionalism, market control, and politics (Blomgren & Sahlin,