'Patient satisfaction': knowledge for ruling hospital reform--an institutional ethnography.

Driven by funding restraint, Canadian health-care has undergone over a decade of significant reform. Hospitals are being restructured, as text-based practices of accountability bring a new business-orientation into hospital and clinical management. New forms of knowledge, generated through records of various sorts, are a necessary resource for managing care in the new environment. This paper's research uses Canadian sociologist Dorothy E. Smith's institutional ethnographic methodology to critically analyse one instance of text-based management. I analyse information about 'patient satisfaction' as it is generated through a patient survey (in which I was implicated through my involvement with a hospitalized family member). Subsequently, I have studied the management environment into which that information would be entered. I argue that in the instance analysed, the information becomes part of a dominant consumer oriented healthcare discourse that subordinates concerns about 'what actually happened' as a professional caregiver would have known it. On this basis, I contend that this sort of taken-for-granted approach to making decisions about quality care in hospitals may be seriously, even dangerously, flawed.