Title page for ETD etd-07162008-221106

Type of Document Dissertation
Author Farquhar, MaryBeth Anne
Author's Email Address mafarquh@vt.edu
URN etd-07162008-221106
Title Actor Networks in Health Care: Translating Values into Measures of Hospital Performance
Degree PhD
Department Public Administration and Public Affairs
Advisory Committee
Advisor Name Title
Rees, Joseph V. Committee Chair
Hult, Karen M. Committee Member
Khademian, Anne Meredith Committee Member
Murray, William L. Committee Member
Phillips, Sally J. Committee Member
Wolf, James F. Committee Member
  • the National Quality Forum
  • hospitals
  • governance
  • performance measurement
  • public policy
  • networks
  • actor-network theory
  • health care policy
Date of Defense 2008-06-30
Availability unrestricted
The health care system within the United States is in a state of transition. The industry, confronted with a variety of new technologies, new ways of organizing, spiraling costs, diminishing service quality and new actors, is changing, almost on a daily basis. Reports issued by the Institute of Medicine raise quality issues such as avoidable errors and underuse/overuse of services; other studies document regional variation in care. Improvement in the quality of care, according to health care experts is accomplished through measuring and comparing performance, but there are a number of disparate actors involved in this endeavor. Through a network of both public and private actors, collaboration on the development of a set of national performance measures is underway. Organizations such as the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS) and other have formed networks to develop and standardize performance measurement systems that can distinguish between quality services and substandard ones. While there is some available research about the processes involved in performance measurement system design, there is little known about the factors that influence the development and work of the network, particularly the selection of hospital performance measures. This dissertation explored the development of a national performance measurement system for hospitals, using an institutional rational choice perspective and actor-network theory as frameworks for discussion. Through qualitative research methods such as direct observation, interviews, participant observations and document review, a theoretically informed case study of the NQF’s Hospital Steering Committee was performed, to address the following questions: How is a national performance measurement system developed and what is the role of federal agencies (e.g., AHRQ and CMS) in the process?
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