When Reactivity Fails: The Limited Effects of Hospital Rankings

Various lines of social research have put forward the idea that modern society is replete with numerous measuring activities that are often focused on evaluating the performance of individuals, organizations, or states. Frequently these measurements are taken by independent third-parties, which are supposed to guarantee the impartiality and trustworthiness of the process in contrast to the presumed self-interest of the actors performing the services in question. Both the application and the research of such measures suggest that the actors under scrutiny will internalize the expectations associated with these measures and adjust their behavior accordingly (“reactivity”). Usually these expectations are not just of a technical nature but involve a moral component of trying to improve the activities in question in a way such as to make them more beneficial, efficient, equitable and transparent for the consumer and society in general. While such measurement schemes are certainly ubiquitous, current research instantaneously equates their widespread presence with their efficacy, i.e. that their implied behavior-altering capacity is inevitably achieved. This argument overlooks that the coupling of measurement and behavioral change is mitigated by the interpretative processes of the actors under examination. Not the mere presence of the measurements but how the actors make sense of them grants relevance to measures and potentially induces behavioral modification. Using examples from the U.S. hospital sector, the proposed paper shows that patients, medical professionals, and hospitals do not simply conform to the expectations created by hospitals rankings but rather show different forms of resistance, such as ignorance or rejection. Thereby the paper highlights that the conditions under which measures prove inescapable and substantially influence social fields need to be examined more closely.