Nathan Emmerich

Earlier in the year I co-authored a paper in BMC Medical Ethics. It was part of a cross-journal special issue on the Many Meanings of Quality in Healthcare and argued that the evaluation of ‘care’ held significant potential for symbolic violence. The main thrust of my paper was that the auditing of specific health and social care institutions necessarily involved a certain level of bureaucratic standardization. As such, the work of bodies like the Care Quality Commission (CQC) involve the imposition of a formal evaluative framework, one that reduces the thick context(s) of practice and care to a thin, semi-quantified, account structured by the requirements and imperatives of bureaucratic evaluations and a culture of audit. In short, bodies like the CQC are organized so that, albeit implicitly, they care less about the quality of care than they do the bureaucratic evaluation of the quality of care. Put another way, we might say that our ability to audit the quality of care lacks a certain degree of nuance and, therefore, quality.