Investing in Non-Qualculability: Overseeing Quality in Dutch Healthcare Settings

• In Event: State Numerology: Conceptual and Ethnographic Engagements with Numbering Practices and Ontologies

Abstract

Much discussion on the neoliberal state has focussed on the ways in which numbering practices have become pervasive in organisational life. The state, as a disciplinary machine, has used technologies of quantification as a means to govern public organisations (and citizens alike) ‘at a distance’. In STS and other literatures, this emphasis on quantification has been critiqued, showing the ‘perverse’, ‘reactive’ or ‘constitutive’ effects of numbering practices (Dahler-Larsen, 2013; Espeland & Sauder, 2016). In our own work on technologies of quantification in healthcare and academic settings, we have encountered many such effects, showing how actors within public organisations use quantification as a means to restructure work practices (Bal, 2017; Wallenburg, Quartz, & Bal, 2016). Similarly, however, we have come across many instances of resistance to quantification, interrupting the quantification machine. In this paper we analyse some of these interruptions as investments in non-qualculability, asking what kind of work is needed to make healthcare resist quantification?
We do this by analysing some projects and methods we encountered along the way of researching quality of care regulations in Dutch healthcare, looking at investments in narrative accountability, appreciative inquiry and the use of soft intelligence by regulatory actors respectively. While not all of these have been developed explicitly as methods to resist and interrupt quantification, we analyse them as such, showing how they have reframed healthcare quality assurance. We discuss what kinds of investments are needed to create non-qualculability and how this is embedded within wider regulatory discourse and practice.

Authors

• Roland Bal, Erasmus University Rotterdam

• Iris Wallenburg, institute for Health Policy and Management