(In)completing Accounting: Financial Managers and Quality Reforms in the Danish Health System

This study investigates the way that managers operating in the Danish health system encounter, make sense of, and enact a series of different reforms equipping and encouraging them to attend to and improve the quality of medical care. Our attention focuses on the conditions under which managers are enabled to perceive the incompleteness of the accounting systems and metrics, which shape and are shaped by how the reforms are enacted and what they ultimately mean in practice. On this basis we offer novel insights into the process we refer to as incompleting accounting, which we show involves and relates to managerial actions and intentions, and design characteristics of the accounting systems themselves. Illuminating the relationship between incompleting accounting at the level of practice, and completing quality at the level of policy, also allows us to provide a normative assessment of the different quality improvement regimes. Finally, we contribute to debates about the breaking down of distinctions between medical and managerial forms of knowledge and action, highlighting among other things a new direction of hybridization brought about as an indirect effect of accounting for quality.