Øyeblikkbildenes autoritet: Om tall som styringsteknologi i de kommunale helse- og sosialtjenestene

This dissertation is an interactionist and constructivist, multi-site ethnography of a multipurpose managerial statistics system for municipal health and care services in Norway. The system is called IPLOS, an acronym for "Statistics linked to individual needs for care", and is used to measure the assistance need and "functional disability level" of citizens who applies for or receives assistance from these services. The dissertation explores how the statistical data and the statistics system, when implemented into health care and health administrative practices, function as a tool of governance in these services. The research has approached the topic top-down, bottom-up and sideways; through document studies, interviews, and participant observation; taking perspectives from state and municipal government, from service users and interest organizations, and from frontline service providers. The dissertation consists of four published articles and an extended introduction. In the introduction I discuss the theoretical positioning of the dissertation as a whole, methodological issues that cross article boundaries and stretch article-length limitations, and overall interpretations that emerge when the articles are read together as a whole. The first article maps topics of relevance for understanding why the managerial statistics system has produced controversy, in particular among service users and interest organizations. The second article explores the development of IPLOS and social interests that interacted with this process. The third article analyzes the relation between the data reporting and the assistance needs measurement practice of front-line service providers in the municipalities. The fourth article explores the practice of municipal front-line service providers further. It analyzes how service providers make the numbers organizationally relevant, for instance to coordinate their own work processes, and how they manage the numbers when these get used both as client data and budget data in local managerial practices. Overall, the articles show that the numbers affect municipal health and care service practices from within - even in situations where the managerial statistics system gets used for descriptive purposes only. In other words, in measuring we coconstruct both the descriptive numbers and the phenomena they describe. When the measurements become high stakes numbers, for instance in budget contexts, the reconstruction of both the numbers and the world described can be even more dramatic