Performance indicators, healthcare management and organizational rationality

Reports into the infamous mismanagement of care at the (UK) Mid Staffordshire NHS Foundation Trust (2005-2008) suggested a prioritization of performance indicators significantly jeopardized patient safety. We contend a range of critical theories addressing rationality and ideology can explain this historic case of the use of targets to guide resource management. Drawing initially on radical Weberian sociology, we argue this use of target-setting management was a classic victory of formal over substantive rationality. We argue subsequently that such analysis be joined by wider theorizing to elucidate the ideological mechanisms behind ‘deliverology’ (Barber, 2015). We draw inter alia on writings by André Gorz, Michel Foucault and the Frankfurt School – and notions of economic rationality, governmentality, and technocratic rationality – to illuminate ideological reasons for deploying performance indicators in healthcare. The result is a critical-pluralist analysis of organizational culture and change: one that assembles a range of social and organizational theories to explain practices at the heart of the Stafford Hospital scandal.