Holding American hospitals accountable: rhetoric and reality

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.