Abstract
Our study aims to understand whether and how the use of performance measures in the context of healthcare organizations facilitates the dynamics of compromise or whether it creates moral struggles among a wide variety of actors. It offers novel insights into the role of performance measures by investigating its underlying moral dimension. Drawing upon the theoretical framework of Boltanski & Thévenot (1991), the sociology of worth theory, this paper examines how actors negotiate and compromise over time concerning issues of justice involving the use of performance measures on a day-to-day basis. We draw on a single case study of a medical unit in a French public hospital. Data were obtained through the ethnographic method, fifty-one semi-structured interviews, and internal financial and accounting documents. Unlike earlier accounting studies, the authors analyze whether, and how, accounting, on one hand, contributes to the dynamics of compromise within French public hospitals between actors with divergent values – administrative and physicians-, and, on the other hand, increases tensions among actors with convergent values involved in caregiving. This offers practical insights into three relational mechanisms underlying the dynamics of compromise and their limits through the time dimension. This study helps managers of healthcare organizations to understand the relationships between the use of performance measures and their impact on the evaluation of worth in practice. In terms of theoretical contribution, the authors develop an original approach to understanding the ambivalent role of performance measures in bringing together divergent values within French public hospitals.