Translating value-based healthcare into practice
In this paper, we report from an experiment into healthcare governance called ‘new governance in the patient’s perspective’ (NG) initiated by a Danish Region. The experiment was inspired by principles of value-based health care (VBHC), and initiated to transform governance from a productivity-regime, allegedly incentivizing clinical conduct in ‘perverse’ and counter-productive ways, towards a new regime focusing on value for the patient. Pursuing this ambition the Region exempted nine hospital departments from activity-based financing based on Diagnosis-Related Groups (DRG), and asked instead the departments to develop self-chosen indicators to measure and account for ‘value for the patient’. Drawing on the notion of ‘translation’ (Latour, 1987) we analyse how NG was put into practice in the departments, and how their indicators were accounted for. Relating to literature on performance indicators, our case seemingly confirms a wellestablished distinction between indicators for internal improvement vs. external accountability. However, in pointing out the dialogues facilitated by the indicators between the Region and the departments, this distinction is challenged. Our analysis provides inspiration for healthcare governance to think of indicators as means, not for purely data-driven governance, but for dialogical practices in which concerns with accountability and local quality improvement conflate.