ABSTRACT
This chapter summarizes the main results of this study. This investigation showed how every form of hospital performance comparison had to address matters of comparability, find appropriate criteria, and justify their use. Moreover, each form of performance comparison subsequently resulted in different problems for hospital care in relation to different environments, including patients, regulators, and staff. Therefore, these comparisons have entailed novel and often pervasive forms of observing medical performance but have not become authoritative and consistently legitimate ways of assessing performance. The case of U.S. hospitals underscores that such comparisons do not inevitably diffuse or unimpededly dominate the control of an organization and its field of activity. The result is a highly complex context of performance assessment in which a multitude of performance comparisons with different and sometimes incompatible criteria as well as in different stages of implementation and enforcement coexist. At the same time, the concept of hospital performance has somewhat dissipated in an abundance of distinctions or aggregated oversimplifications. But even without fulfilling their high expectations, performance comparisons persist. Finally, the chapter outlines implications for further research into performance comparisons. These include focusing more on the institutionalization and actual implementation rather than the ubiquity of performance comparisons, widening the time frame of the investigation, and distinguishing between the control of organizational decisions and structures.
