APPLYING THE STRAUSSIAN FRAMEWORK OF ACTION, NEGOTIATION, AND SOCIAL ARENAS TO A STUDY OF ACCOUNTABILITY IN HOSPITALS

Abstract

Millions of dollars are being spent on the quest for the best means to assess, monitor, and the quality of health care in the United States and on making physicians, health plans, and hospitals accountable. Toward this end, participants in this ever-expanding arena are earnestly trying to develop universal quality standards and regulatory mechanisms. Hospital personnel are desperately trying to adapt to this imperative under two significant conditions that are prompted by the drive to stem costs : (1) the redesign of hospitals, resulting in extensive changes in work roles and the division of labor; and (2) the provision of clinical procedures on an outpatient basis to reduce the length of hospital stay. Consequently, patients who are hospitalized are much sicker than they used to be, while nursing and support staff have been reduced to save money. Meanwhile, a disjunction exists between the nature of quality being measured and the meaning people place on their experiences with health care delivery. Based on five years of research that focused on the evolution of the enterprise, this article demonstrates the usefulness of the framework that was central to the work of Anselm Strauss action, negotiation, and social arenasfor analyzing this complex endeavor. The fit of business techniques and methods currently being used to advance hospital is viewed in relation to the complexity of medical work and the fast pace of change in biotechnology. Amid the pressure to curtail health care spending, an elaborate enterprise costing millions of dollars has been constructed for the purpose of assessing and monitoring the quality of health care in the United States in an effort to improve performance/' in the current language, and to make physicians, health plans, and hospitals more accountable. A growing cadre of people computer specialists, researchers, health care economists, health policy experts are earnestly seeking the means to measure the outcomes of hospital care. This accountability endeavor is occurring under two significant conditions that are prompted by the drive to stem * Direct all correspondence to: Carolyn L. Wiener, Box 0610, Department of Physiological Nursing, University of California at San Francisco, San Francisco, CA 94143; e-mail : carolyn.wiener@nursing.ucsf.edu. Sociological Perspectives, Volume 43, Number 4, pages S59-S71. Copyright © 2000 by Pacific Sociological Association. All rights reserved. Send requests for permission to reprint to: Rights and Permissions, University of California Press, Journals Division, 2000 Center St., Ste. 303, Berkeley, CA 94704-1223.