Quality reports as an instance of intermediation in competition between hospitals: Patients as rational actors

Messer M, Reilley J. Qualitätsberichte als Vermittlungsinstanz im Wettbewerb zwischen Krankenhäusern: Patienten als rationale Akteure. Berliner Journal für Soziologie. 2015;25(1-2):61-81.With the introduction of hospital quality reports (QR), hospitals are required to make defined quality information available to patients, in accordance with provisions of the German Federal Joint Commission (G-BA). Based on this empirical example the paper traces how actor-specific criteria for rationality are intermediated and how a convergence of actor-specific rationalities has been attempted with the establishment of structured QR. From an actor-network theory perspective, it shows how the initiation of QR serves as a central instance of intermediation in a network. QR are connected to a perspective from which quality competition between hospitals is economically rational. At the same time, these reports should strengthen possibilities for active participation among patients. However, the QR hardly entices any kind of appreciation from patients who still follow their individual sense for what is rational. It becomes clear that the actors find themselves in an early phase of their convergence, where they wrestle over the mutual adaptation of their rationalities. If instigating actors like the G-BA do not come closer to patient rationalities, then the development of a network based on QR threatens to end in a stalemate