When reactivity fails: The limited effects of hospital rankings

Abstract

Recent research has advanced the idea that modern society is replete with numerous measuring activities that evaluate the performance of individuals and organisations. Both the research and the application of such measures suggest that the scrutinised actors will internalise the expectations associated with these measures and adjust their behaviour accordingly (‘reactivity’). Usually these expectations involve both technical and moral demands aimed at improving the evaluated activities so as to make them more beneficial, efficient, and transparent for the consumer and society in general. However, both research and practice instantaneously equate their widespread presence with their efficacy, i.e. that their implied behaviour-altering capacity is inevitably achieved. This overlooks that the coupling of measurement and behavioural change is mitigated by the sensemaking processes of the examined actors. Using examples from the US hospital sector, this article shows that patients, medical professionals, and hospitals do not simply conform to the expectations created by hospitals rankings but rather show different forms of resistance, such as ignorance or rejection. Thereby, the paper highlights that the conditions under which measures prove inescapable and substantially influence social fields need to be examined more closely.