Government by standards: The making and managing of accountability in Danish hospitals

Since 2009, all Danish hospitals have been subjected to a comprehensive, mandatory accreditation system, the so-called Danish Quality Model (DDKM), in order to assure the quality of hospital services. So far there is no evidence of DDKM’s positive effects on clinical outcome and it may even be contributing to accountability overload. This article seeks to provide an explanation for why hospital staff seems to accept, albeit grudgingly and partially, the imposition of a new, comprehensive accountability system with questionable clinical merits. Inspired by Michel Foucault’s analytics of government, it is argued that the accreditation system is hard to refuse because it promises to increase the quality of hospital services and, more importantly, because the procedural standards espoused by DDKM work through the structured and accountable freedom of medical staff.