Promising performativity. Qalculating clinical performance?

• In Event: How Do STS Studies Translate Numbers: Knowledge, Theory, Method

Abstract

STS scholars have well pointed out the politics of numbers, highlighting how numbers intervene in practices, bringing into being particular value systems rather than ‘just’ reflecting their performances (Callon 1998; Verran 2001). Cases in point are scores on performance indicators for professional organizations such as universities or hospitals and the subsequent ‘ranking’ of their performance (Wallenburg et al. 2016). This ‘reactivity’ to numbers, while taken up by scholars as a critique of numbering practices (Espeland and Sauder 2016) hardly is a surprise to practitioners—that is, policy makers, regulators, and, in case of health care, (associations of) physicians and nurses—anymore either. Although some stubbornly attempt to combat these effects, casting reactivity as a threat to the validity of counting practices, others view reactivity as ‘a promise’, seeking to create a form of reactivity that causes people to change their behavior in desired ways.

We encountered such policy attempts in our research on the construction and use of performance indicators among the Dutch Healthcare Inspectorate. While we had pointed out the reactivity of their work in earlier research projects, they now embraced this insight, anticipating the (wished for) futures of performance indicators to enhance quality of care. Moreover, inspectors actively and enthusiastically consulted us, STS scholars interested in the politics of numbers, to enhance insight in their own performative work. In this paper, we explore our (unexpected) reflective consultancy work as a form of qalculation (Cochoy 2008), rendering STS analytics in collective work of understanding and experimenting with the world making practices of numbers.

Authors

• Roland Bal, Erasmus university rotterdam

• Iris Wallenburg, institute for Health Policy and Management