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Accountability through Measurement: A Global Perspective
  1. M Marshall
  1. National Primary Care Research and Development Centre, Manchester M13 9PL, UK; martin.marshall{at}

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    V A Kazandjian. Milwaukee, USA: American Society for Quality Press, 2003. $45.00, 353 pp. ISBN 0873895673

    The term “accountability” is fast becoming a mantra for policy makers and politicians. Wherever we turn we hear that organisations and health professionals are insufficiently accountable, that health system reform needs to focus on increasing accountability, and that new mechanisms and tools are required to deliver greater accountability. Despite this interest, much of the discussion fails to be explicit about who should be accountable to whom and for what. A book entitled Accountability through Measurement is therefore likely to grab the attention of many people working in the health sector.

    The book is a weighty tome which covers an enormous amount of ground. The first half explores how accountability can be conceptualised and then operationalised. The model presented is an innovative one which encompasses and integrates the nature of knowledge, professionalism, performance, and expectations. The ideas draw on a wide range of disciplines, though less on sociology than one might expect given the nature of the subject. Some of the thoughts in these early sections are more relevant to a US audience, citing the work of agencies such as the JCAHO and the NCAA. The second half of the book presents a series of case studies from a range of different countries and more accurately reflects the book’s subtitle A global healthcare imperative. The case studies demonstrate the importance of the cultural environment to how accountability is defined—from the philosophical and professionally orientated approach adopted in Austria to the technical and managerially orientated approach adopted within the Veterans Administration in the US.

    The complexity of the ideas presented in this book ensures that it is not a particularly easy read and it is unlikely that busy managers and clinicians will want to read it from cover to cover. The underlying thesis is largely a technical one, which rarely questions whether the science of measurement really should be the foundation stone on which accountability is built. The book is unlikely to appeal to those who want to explore the tension between those who call for greater accountability and those who espouse the more traditional value of trust. Nevertheless, it makes a significant contribution to a topical subject and undoubtedly takes our thinking forward in a complex area of health policy.