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.