title: Holding American hospitals accountable: rhetoric and reality.
abstract: Assessing the vast arena that continues to grow in pursuit of accountability in American hospitals, this paper raises the following question: Is this enterprise geared toward making hospitals better or toward making them only look better? 'Accountability' has become an umbrella concept to signal the need to demonstrate - to others - that performance is being measured and perfected. The author asserts that there is an imperfect fit between health-care and the industrial model being used to measure quality of care due to four problematic issues: the nature of contemporary patient care, the overstating and overselling of accountability proposals, inflated expectations placed upon 'rationalization', and insufficient attention afforded accident and error. The paper concludes with a plea for reconsideration of the tilt toward a business approach to health-care, asking if, in our zeal to hold hospitals accountable, we are measuring what is important or simply making important what we can measure.
authors.affiliation: School of Nursing, University of California San Francisco, San Francisco, California, USA. cwiener@tsa.ucsf.edu
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Wiener
mesh_terms: D000056:Accident Prevention; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002140:California; D017046:Cost Savings; D019317:Evidence-Based Medicine; D006302:Health Services Research; D006739:Hospital Administration / Q000191:economics / Q000592:standards*; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D017146:Models, Organizational; D020380:Needs Assessment / Q000458:organization & administration; D015404:Nursing Methodology Research; D015279:Organizational Culture; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D010564:Personnel, Hospital / Q000523:psychology; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012941:Social Responsibility; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States