‘Improving ratings’: audit in the British University system

Strathern, Marilyn

doi:10.1017/s1062798700002660

Cited by 290 publications

(181 citation statements)

References 1 publication

Supporting

Mentioning

176

Contrasting

Unclassified

Order By: Relevance

“…Whenever extreme pressure (in the form of financial rewards or penalties) is placed on a metric, human nature guarantees that complications will follow; recent well-publicized examples include widespread gaming that occurs when law enforcement is under pressure to lower crime rates (25) or when teachers are under pressure to improve student test scores (26). This phenomenon is known as Goodhart's law: "when a measure becomes a target, it ceases to be a good measure" (23,27,28).…”

Section: Use and Misuse Of Surveillance Definitionsmentioning

confidence: 99%

Rising Stakes for Health Care-Associated Infection Prevention: Implications for the Clinical Microbiology Laboratory

Diekema

2017

J Clin Microbiol

View full text Add to dashboard Cite

Health care-associated infection (HAI) rates are subject to public reporting and are linked to hospital reimbursement from the Centers for Medicare and Medicaid Services (CMS). The increasing pressure to lower HAI rates comes at a time when advances in the clinical microbiology laboratory (CML) provide more-precise and -sensitive tests, altering HAI detection in ways that may increase reported HAI rates. I review how changing CML practices can impact HAI rates and how the financial implications of HAI metrics may produce pressure to change diagnostic testing practices. Finally, I provide suggestions for how to respond to this rapidly changing environment.KEYWORDS clinical microbiology, infection prevention, nosocomial, pay for performance, health care-associated infections C onsider the following three scenarios related to the role of the clinical microbiology laboratory (CML) in health care-associated infection (HAI) surveillance and prevention. In scenario 1, during an investigation of rising rates of central-line-associated bloodstream infection (CLABSI), the infection prevention program (IPP) notes that some CLABSIs were due to organisms that grew in only one of several blood cultures and which, prior to the institution of matrix-assisted laser desorption-ionization time of flight (MALDI-TOF) mass spectrometry for organism identification, would have been classified as contaminants. An example included a CLABSI attributed to an unusual species of Actinomyces that previously would have been categorized as a "diphtheroid." Your hospital leadership requests that you either revert to former identification methods or change your reporting in a way that prevents these events from being classified as CLABSIs.In scenario 2, since you changed to a nucleic acid amplification test (NAAT) for Clostridium difficile detection, your positivity rate has increased by over 100%. The rate of hospital-onset C. difficile infection (HO-CDI) has increased similarly. During an investigation of the increase in CDI, you find that many samples positive by NAAT are toxin negative by enzyme immunoassay (EIA) and that many patients with a low pretest probability of disease are being tested. However, after an initiative to improve testing practices, your HO-CDI lab identification (LabID) event rate remains high (standardized infection ratio [SIR], Ͼ1). Concerned about how this rate will impact the value-based purchasing (VBP) and health care-associated condition (HAC) scores, your hospital leadership asks you to consider a change back to EIA for CDI diagnosis.In scenario 3, even after a campaign to reduce your hospital's rate of catheterassociated urinary tract infection (CAUTI) through a reduction in catheter use and improvement in catheter placement and care, the CAUTI rate remains unacceptably high. Your hospital epidemiologist sets up a meeting with you to discuss how to reduce the number of urine cultures ordered or performed by the laboratory as another way to reduce both the CAUTI rate and unnecessary antibiotic use. She is...

show abstract

Section: Use and Misuse Of Surveillance Definitionsmentioning

confidence: 99%

Rising Stakes for Health Care-Associated Infection Prevention: Implications for the Clinical Microbiology Laboratory

Diekema

2017

J Clin Microbiol

View full text Add to dashboard Cite

show abstract

“…This is manifested in an 'audit explosion' in universities (Strathern 1997), as a defence against systemic arbitrariness. Audit mechanisms are designed to ensure organisational precision for coping with (appropriate) social imprecision.…”

Section: How and Who: Research Training As Risky Businessmentioning

confidence: 99%

“…As Strathern (1997) avers, technology 'comes with the friendliest of epithets' (p. 317) in the audit culture -the more of it used in ways that the organisation approves, the better. Thus the self-managing academic demonstrates improved teaching performance by pointing to the use of more and newer information communication technologies (ICTs).…”

Section: How and Who: Categories And Cases Of Riskmentioning

confidence: 99%

See 1 more Smart Citation

Towards a research training curriculum: What, Why, How, Who?

McWilliam

Singh

2002

Aust. Educ. Res.

View full text Add to dashboard Cite

Our purpose in this paper is to investigate the ways in which the work of research higher degree supervision is being reshaped from within and outside universities. Our interest is in the means by which new 'content' and 'process' knowledge -and thus a new set of pedagogical tasks and relationships -are being configured in the field of higher degree research. The outcomes of research training have traditionally been products of a one-on-one supervisory relationship, that is, academic apprentice-todisciplinary mentor. This is especially the case in the fields of arts/humanities. Any 'curriculum' necessary to such a model has been both implicit and at the discretion of the disciplinary 'master'.The paper maps the reasons that this model is being challenged, the policy and other mechanisms that are representing this challenge, the new modes of conduct and the new knowledge being produced by these policies and mechanisms, and the new pedagogical identities being forged as a result. We argue that the know-how of the academic supervisor is no longer coterminous with research training as 'expert' work. While disciplinary knowledge will continue to be important, and while one-on-one supervisory relationships will remain, they are unlikely to dominate the new higher degree research training landscape. New modes of knowledge production and new organisational arrangements are demanding different knowledge -less certain, less discipline specific -and different work -more team-based, more trans-disciplinary, and more accountable.

show abstract

“…Foundational to this understanding of risk will be the notions of risk and the risk society explored in sociological and anthropological literature, particularly in the seminal work of Douglas (1992), Beck (1992), and Giddens (1990). Second, the paper juxtaposes this understanding of risk with the rise of accountability imperatives and an "audit culture" (Strathern, 1997) in public institutions, including schools. It then moves to consider how a systems-based approach to risk management, drawing on Reason's (1990) model of human error minimisation, could be usefully developed for schools.…”

Section: Introductionmentioning

confidence: 99%

Risk, error and accountability: improving the practice of school leaders

Perry¹

2006

Educ Res Policy Prac

View full text Add to dashboard Cite

This paper seeks to explore the notion of risk as an organisational logic within schools, the impact of contemporary accountability regimes on managing risk and then, in turn, to posit a systems-based process of risk management underpinned by a positive logic of risk. It moves through a number of steps beginning with the development of an understanding of risk, the risk society and the logic of risk derived from the seminal work of Douglas (1992, Risk and blame: essays in cultural theory, London: Sage), Beck (1992, Risk society: towards a new modernity. London: Sage) and Giddens (1990, The consequences of modernity. Cambridge: Polity Press). Second, the paper juxtaposes this understanding of risk with the rise of accountability imperatives and an "audit culture" [Strathern (1997) European Review, 5(3), 305-321] in public institutions, including schools. It then moves to consider how a systems-based approach to risk management, drawing on Reason's (1990, Human Error. New York: Cambridge University Press) model of human error minimisation, could be usefully developed for schools. Such an approach would be built on a positive risk logic which maintains the flexibility, innovativeness and adaptability so necessary in education and avoids the more deleterious effects of many current forms of accountability and risk management which reflect avoidance, conformity and rigidity.

show abstract

‘Improving ratings’: audit in the British University system

Cited by 290 publications

References 1 publication

Rising Stakes for Health Care-Associated Infection Prevention: Implications for the Clinical Microbiology Laboratory

Rising Stakes for Health Care-Associated Infection Prevention: Implications for the Clinical Microbiology Laboratory

Towards a research training curriculum: What, Why, How, Who?

Risk, error and accountability: improving the practice of school leaders

Contact Info

Product

Resources

About