Making the user useful? How translation processes managerialize voice in public organizations

Reilley, Jacob; Balep, Nathalie Iloga; Huber, Christian Article — Published Version Making the user useful? How translation processes managerialize voice in public organizations Financial Accountability & Management Provided in Cooperation with: John Wiley & Sons Suggested Citation: Reilley, Jacob; Balep, Nathalie Iloga; Huber, Christian (2020) : Making the user useful? How translation processes managerialize voice in public organizations, Financial Accountability & Management, ISSN 1468-0408, Wiley, Hoboken, NJ, Vol. 36, Iss. 4, pp. 401-419, https://doi.org/10.1111/faam.12249 This Version is available at: https://hdl.handle.net/10419/230062 Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in EconStor may be saved and copied for your personal and scholarly purposes. You are not to copy documents for public or commercial purposes, to exhibit the documents publicly, to make them publicly available on the internet, or to distribute or otherwise use the documents in public. If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence. http://creativecommons.org/licenses/by-nc/4.0/ Received: 22 February 2019 Revised: 16 March 2020 Accepted: 17 March 2020 DOI: 10.1111/faam.12249 RESEARCH ARTICLE Making the user useful? How translation processes managerialize voice in public organizations Jacob Reilley1Nathalie Iloga Balep1Christian Huber2 1Faculty of Economic and Social Sciences, Department of Management Accounting and Control, Helmut Schmidt University, Hamburg, Germany 2Department of Operations Management, Copenhagen Business School, Frederiksberg, Denmark Correspondence Jacob Reilley, Faculty of Economic and Social Sciences, Department of Management Accounting and Control, Helmut Schmidt University, Holstenhofweg 85, 22043, Hamburg, Germany. Email: [email protected] Funding information Deutsche Forschungsgemeinschaft, Grant/Award Number: 627097 Abstract One of the most pervasive topics in public management discussions in recent decades is the notion of user orientation. More than ever, external stakeholders expect public organizations to “get closer” to users and to treat citizens as knowledgeable consumers of public services with a view and a voice. Existing literature highlights how, through a wide range of calculative practices, information gathered from and about public service users is assembled into descriptions of organizational activity that are useful for managers in addressing issues of surveillance and internal control as well as legitimation. In our multiple case study of hospitals and prisons in Germany, we introduce a two-step model of translation for explaining how user voice is transformed into management objects, which are then further translated into organizationally “useful” information. In doing so, we make three contributions to further our understanding of how user views are formatted to organizational activity and put to use by managers in the public sector. First, we developed a model of translation that highlights how user voices and the prospect of user orientation are enacted across diverse organizational contexts. Second, we found that different types of organizations deploy distinct methods of accounting, which nevertheless make user feedback useful in similar ways: to develop information that helps construct an image of performance, gain financial leverage, and enact compliance. Third, we found that in addition to quantitative forms of accounting, narrative accounting techniques played important roles in making users “useful” in public organizations. KEYWORDS accounting, management, translation, usefulness, user voice This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. c 2020 The Authors. Financial Accountability & Management published by John Wiley & Sons Ltd Financial Acc & Man. 2020;36:401–419. wileyonlinelibrary.com/journal/faam 401 402 REILLEY ET AL. 1INTRODUCTION Relationships between public sector organizations and public service users have changed quite a bit over the past several decades. With the rise of New Public Management (Hood, 1991; Hyndman & Lapsley, 2016), individuals have been increasingly addressed as knowledgeable consumers of public services, rather than as passive claimants (Arnaboldi, Lapsley, & Dal Molin, 2016; Köppe, Ewert, & Blank, 2016; Watkins & Arrington, 2007). Under a “user-oriented” public management paradigm, the citizen has been idealized as a user with a view and a voice, someone whose opinions and experiences ought to be considered when assessing service provision (Pflueger, 2016). The push toward more user orientation has been articulated in numerous reforms (Fotaki, 2011), many of which intend to embolden individuals and grant them new avenues for participation (Newman & Clarke, 2009; Richardson, 1983). Increased attention to users, however, is not always an end in itself, but the means to achieving broader managerialist goals (Fountain, 2001, p. 59). According to proponents of a “customer-focused agenda” in the public sector, “getting closer” to users is the key to ensuring quality, holding providers accountable, and increasing efficiency (Osborne & Gaebler, 1992; Pfeffer & Coote, 1991). Thus, the rhetorical conversion of the citizen into an active assessor of service delivery is not merely about empowerment; it is also a strategic attempt to constrain user voice so that it only speaks in organizationally useful terms (cf. O’Leary & Miller, 1987, p. 261). Within this context, managers of public organizations have found a number of ways to “make use” of user voices by formatting them to organizational activity. Most commonly, this is accomplished through quantitative practices of accounting. Satisfaction surveys, balanced scorecards, quality indicators, and various other accounting instruments are employed within public organizations to transform user opinions and concerns into numerical terms. Such quantitative accounting techniques do not necessarily reflect the preferences and opinions of service users. Rather, they mediate what aspects of user voice are actually brought to the attention of managerial staff (Pflueger, 2016). Through accounting, user voice becomes embedded in decision-making processes (Boyce, 2000; Simmons & Brennan, 2017; Wisniewski, 2001), where it can be used to hone an organization’s image (Fountain, 2001) or demonstrate performance toward external stakeholders (Christensen, Newberry, & Potter, 2018). So, although reforms have propagated the idea that users should voice their opinions, the tools deployed to “listen in” have distorted what is heard and acted upon within organizations. In this paper, we focus on the ways in which different organizations attempt to “make users useful”; that is, how managers and others translate the opinions, experiences, and desires of individuals into management objects, which can then be used to achieve organizationally defined aims. Despite the push toward more user orientation in public services, we know relatively little about how the prerogative for organizations to incorporate user voice is operationalized in organizational practice. To address this gap, we draw on a multiple case study of hospitals and prisons in Germany. Our study makes three contributions. First, we develop a model of translation, which helps conceptualize how different types of public organizations make users “useful” through various forms of accounting. With this model, we open up possibilities for comparing diverse types of organizations, which encounter similar reform pressures. Second, we shed light on how different types of organizations make user feedback useful in similar ways: to develop information that can help construct an image of performance, gain financial leverage, and enact compliance. Across diverse organizational contexts, distinct modes of accounting for user voice help organizations satisfy similar interests and goals. Third, we show how, in addition to quantitative accounting, narrative accounting techniques were central in making users “useful” in public organizations. The means for translating voice into something useful for organizations thus appears in multiple forms of accounting, all of which produce an image of voice that is potentially disconnected from actual user concerns. REILLEY ET AL.403 2TRANSLATIONS AND ORGANIZATIONS—MAKING THINGS USEFUL THROUGH ACCOUNTING In the public sector, there is frequently a disparity between stated reform objectives and actual organizational practice (Brunsson, 2006; Czarniawska & Joerges, 1995; Lapsley, 2008; Modell, 2001). Although this is often seen as undesirable by policy makers or practitioners, critics have pointed out that such disparity is inevitable, as organizations use their own framings of problems and solutions to operationalize ideas into action (Czarniawska, 2000; Mouritsen, 1997; Power, 2007). Organizational members construct tools and routines—not necessarily in accordance with external demands, but in ways they find useful for evaluating and managing their everyday work (Garfinkel, 1967, p. 201). These tools and routines, in turn, generate new information about the organization and its relation to wider social contexts (Czarniawska & Joerges, 1995). This is an ongoing process of “translation,” whereby ideas are turned into objects and actions, and again into other ideas (Czarniawska & Joerges, 1995). Along with others, we suggest that the notion of translation helps explain how reform ideas are materialized and framed within organizations. Previous literature has shown how translations are shaped by practices of “accounting” (Brorström, 2018; Czarniawska, 2010). As many have argued, accounting is not only composed of various budgeting and costing activities or formal accounting systems, but also a variety of other ways of “calling for accounts” (Munro, 2001; see also Power, 2015; Robson, 1992). Organizations rely on a wide range of quantitative tools as well as other practices of recording, documenting, and reporting performance. Scholars of organizations have discussed how these practices produce the metrics, documents, and protocols that appear as “management objects”—artefacts that help organizational leaders coordinate day-to-day activity (Czarniawska & Mouritsen, 2009). Literature has repeatedly shown how accounting is particularly powerful in generating material devices, which allow managers to describe and act on entities, processes, and persons “from a distance” (Chapman, Cooper, & Miller, 2009; Miller & Power, 2013). Although management objects may be viewed by practitioners as purely technical means for control, scholars remind us that documents and metrics actually impose patterns of standardization, which make certain activities visible to organizational staff, while ignoring others (Hopwood, 1994). Research has shown us that management objects are not necessarily valued by managers for their representational qualities, but for their “usefulness” in operationalizing and informing locally defined aims (Jordan & Messner, 2012). Such management objects are not inherently useful, but have to “made organizationally useful” through processes of translation (cf. Andon, Baxter, & Chua, 2015). Expanding and challenging the technical and rationalistic understanding of accounting, scholars have highlighted a number of ways in which accounting metrics and reports are used in organizations (Ansari & Euske, 1987; Burchell, Clubb, Hopwood, Hughes, & Nahapiet, 1980). For instance, Burchell et al. (1980) discussed how accounting systems operate as “ammunition machines” insofar as they help “articulate and promote particular interested positions and values” (p. 17). Information garnered from quantitative metrics or internal reports is not merely used for enhancing efficiency or informing decision-making, but also for strategically selecting what is made visible to internal and external constituencies (Burchell et al., 1980, p. 17). Existing scholarship has thus highlighted how management objects can be further translated in such a way that they help further organizational interests, legitimize decisions, or symbolize commitment to particular values (Brignall & Modell, 2000; Feldman & March, 1981; Modell, 2001). In sum, broad reform ideas, such as the notion of user orientation, are translated into management objects, which are capable of coordinating activity or enacting control in organizations; these objects are then further translated and reflected upon by actors as they attempt to assemble organizationally useful information. We have constructed a twostep conceptual model in order to conceptualize how translations unfold across organizational contexts (see Figure 1 below). Although this model distinguishes between two “steps” of the translation process, this is only for analytical purposes and should be read as a heuristic and not as a set of linear cause and effect relationships. This two-step approach allows us to differentiate two aspects of translation that have remained rather opaque in previous work. The first step highlights translations “from voice to management objects.” In the public sector, reform 404 REILLEY ET AL. FIGURE 1 The two-step translation process studied in this paper ideas related to user orientation spark attempts to make user voice into objects—metrics, documents, and protocols— that help manage and coordinate day-to-day activity. What exactly this looks like regarding users in the public sector, however, remains unclear. The second step focuses on translations “from management objects to organizational usefulness.” In this phase, managers reflect on how user voice is useful for resolving broader normative and regulatory demands placed on the organization. With our focus on these translation processes and the phenomenon of user orientation in the public sector, we aim to make three contributions. First, we further develop the translation model illustrated in Figure 1 to highlight how user voice and the prospect of user orientation are translated across diverse organizational contexts. Although existing literature has discussed the many ways in which information is made useful in organizations—either as instruments of control or legitimation—few have taken the opportunity to explore how this relates to user orientation in the public sector. For example, in their study of multidimensional performance measurement in the public sector, Brignall and Modell (2000) suggest that “individual beneficiaries are unlikely to have sufficient power to strongly influence the compilation and reporting of performance information in provider organizations” (p. 283). Given the current trends surrounding user involvement in the public sector, this perspective seems rather antiquated now. Our model addresses this blind spot by providing a template that helps us explore how different organizations attempt to make users “useful.” Second, we address literature that has specifically discussed the role of the user in public sector organizations. Until now, scholars have focused on how information gathered from and about public service users is implicated in practices of accountability (Miller, 1996; Pflueger, 2016; Simmons & Brennan, 2017). Some have shown how user or customer perceptions are utilized within organizations as a means of controlling customers and restructuring organizational practices (Ogden, 1997; Vaivio, 1999). In other cases, contact reports, surveys, and other instruments of evaluation that are supposed to represent the opinions of individuals are used to identify operational problems or manage professional work (Pflueger, 2016). Most of this work focuses on how users are implicated in processes of internal control and surveillance. In other words, existing research only explores how users are framed within organizations up until step 1 of the translation process. We complement this perspective by highlighting how user voice is translated into various management objects, which are then interpreted as useful for constructing an image of performance, gaining financial leverage, and enacting compliance. Third, we draw attention to alternative forms of accounting practices that help make users organizationally “useful.” Much of the current work has focused on the role of calculative practices in shaping how organizations interact with service users. The translations that accommodate user voices to monitoring and control are often conceptualized as chains of either single or multiple calculations (Mouritsen, Hansen, & Hansen, 2009), or as practices of putting words into numbers (Czarniawska, 2000). On the path toward user orientation, public organizations are shown to rely on REILLEY ET AL.405 various quantitative accounting instruments in order to understand user needs or to calculate the economic value of users (Boyce, 2000; Simmons, Birchall, & Prout, 2012). Although we acknowledge that calculative practices play a central role in how organizations address users, we suggest that narrative accounting practices also play a central role in processes of translation. 3METHODOLOGY Our empirical work was based on a multiple case study research design (Eisenhardt & Graebner, 2007; Yin, 2014). This approach allowed us to specify and differentiate the healthcare and criminal justice contexts, and to tease out the multiple ways in which these organizations attempt to meet reform demands surrounding user orientation. Hospitals and prisons are particularly well suited to a multiple case study because they represent a set of “diverse cases” (Gerring, 2007). By including diverse cases in our study, we widen our analytical focus to cover a broad spectrum of circumstances under which organizations translate user-oriented reforms. In German healthcare, policy discussions have increasingly focused on enabling patients in sharing their views on care quality (Blank, 2009; Ewert, 2011; Köppe et al., 2016; Newman & Kuhlmann, 2007). This shift is reflected in hospital management rhetoric as well, where one of the most prominent buzzwords has become “value-based healthcare” (Porter & Guth, 2012), an approach to internal control that seeks to make patient experiences part of quality measurement. The culmination of these trends has made the “user-oriented hospital” (Borchers & Evans, 2011) the model for the future. Against this background, all hospitals are required to implement “patient-oriented” quality management systems, which include a “patient survey.” Prisons, on the other hand, attend to prisoners, who are viewed as much less “consumer like” than patients. The inclusion of user voice in German prisons has therefore received much less attention in public discourses than in health care. However, the perspectives and opinions of prisoners have become an important part of prison organization under the heading of resocialization—next to security, one of the two main aims of German prisons. Since the 1970s, prisons have been required to foster the participation of prisoners in the daily organization of prison life. German penitentiary laws provide prisoners the right to form special interest groups—a kind of “prisoner union” in each prison facility. Prisoner unions should help resocialization processes by fostering independence and responsibility among prisoners before they are released (Feest, Lesting, & Lindemann, 2017). Across cases, we see distinct notions of user participation and distinct ways of accounting for users. Despite such differences, these organizations are quite comparable. Hospitals and prisons face similar expectations to include their respective users in the evaluation of service delivery and to be responsive to user opinions (Newman & Kuhlmann, 2007; Vigoda, 2002). This has been expressed in concrete reforms and regulations as well as expert discourses, which discuss how “human service organizations”—like hospitals and prisons—ought to attend to users’ opinions and complaints (Hasenfeld, 2010). Moreover, in mobilizing different ways of accounting for the service user, hospitals and prisons are both making efforts to attain public goals and interests; they are both exhibiting a specific form of “publicness” (Steccolini, 2019). In focusing on user orientation as a dimension of publicness, we avoid the pitfalls of privileging jurisdictional differences when contrasting cases (Steccolini, 2019). Given the similarity in reform trends surrounding user involvement, and the diverse set of circumstances present in each case, we expected user-oriented reforms to be translated very differently across cases. Based on the literature reviewed above, accounting influences how immaterial things such as reform ideas related to user orientation, or the voices of users themselves, become operationalized in concrete organizational settings. As a consequence, different modes of accounting for service users (patient surveys vs. prisoner unions) should arguably have an effect on how user voice is constructed as “useful” in organizations. We reasoned that these diverse cases would reveal a varied and comprehensive view of how users’ views are dealt with in public organizations (Gerring, 2007, p. 99). This is valuable given the current state of the literature. Not only have there been few studies on how user-oriented reforms become part of organizational practice, but we know little about how or if this particular phenomenon varies across distinct organizational contexts. 406 REILLEY ET AL. In total, we conducted 57 semistructured interviews with actors with management responsibilities. Our sample consists of three hospitals and 10 prisons. The choice of these organizations within each sector was based on random sampling, which is unproblematic given the homogeneity within case groups (Gerring, 2007, p. 100): to translate user voice, all hospitals relied on patient surveys and all prisons relied on prisoner unions. Interviewees included top-level managers; middle managers; and some operational staff. Table A1 contains an overview of how many interviews were conducted and with which personnel. On average, interviews lasted between 45 and 75 min. All interviews were conducted by at least two members of our research team and recorded. Whenever cited, audio files were transcribed and translated into English by the authors. Our interviews were complemented by extensive document analysis and participation in altogether 14 expert and practitioner conferences. Media publications, practitioner handbooks, and public statements by interest groups as well as various internal documents helped shed light on broader contextual information, that is, the user-oriented discourses and legal frameworks in health care and criminal justice. Combining various sources of evidence from the qualitative interviews, the analysis of interviews, internal documents, and archival materials helped triangulate our findings (Jick, 1979; Jonsen & Jehn, 2009). Throughout interviews, experts referred to users when describing various management problems and routines that were relevant in their everyday work. As topics of in-depth discussion in this paper, we chose to focus on all of those instances where users were mentioned in conjunction with management practice. This focus allowed us to exclude moments when interviewees discussed users strictly in professional terms (e.g., when physicians discussed clinical procedures for handling patients; when prison managers discussed the legal constitution of the prisoner) as well as moments when management practice was unrelated to user involvement (e.g., billing procedures; financial reporting). This resulted in our ultimate focus on patient surveys and prisoner unions. For the analysis of the empirical material, we followed an abductive analytical approach, which focused on the interaction among data, existing literature, and emerging theoretical themes (Alvesson & Kärreman, 2011; Mantere & Ketokivi, 2013). This constituted an iterative process in which we employed “empirical material as a resource for developing theoretical ideas” (Alvesson & Kärreman, 2011, p. 12). In an open-coding process, all of the authors reviewed interview transcripts and documents line-by-line to construct categories that reflected the language of the source material. Based on our knowledge of extant literature on translation and the uses of accounting information, we focused specific attention on several core categories of interest, including “reform conditions,” “management tools,” “accounting practices,” and “interpretations of usefulness” as they appeared in our empirical material. We grouped these core categories according to the organizational activities associated with them. Through the coding process, three analytical concepts emerged—constructing an image of performance, gaining financial leverage, and enacting legal compliance—which characterized how information from and about users was made organizationally useful across cases. These similarities shed light on some new theoretical insights by providing a contrast to the original expectations we had for our diverse cases, while also remaining consistent with our empirical data (Eisenhardt & Graebner, 2007). 4RESULTS AND FINDINGS: TRANSLATION PROCESSES AROUND USER VOICE The following sections relate the two-step translation process outlined above to our multiple case study. We show how hospitals and prisons translate the opinions and experiences of individual service users into management objects, which are then used to achieve organizationally defined aims. 4.1 Hospitals 4.1.1 From voice to management objects Within the context of “value-based health care” (Porter & Guth, 2012), as well as policy discussions surrounding the “user-oriented” hospital (Borchers & Evans, 2011), patient surveys have emerged as primary tools for approximating REILLEY ET AL.407 patients’ needs and desires. Although patient surveys are highly standardized tools and thus similar in design, regulatory provisions do not specify how hospitals are supposed to collect patient data, structure information, or use patient feedback to improve care. Each hospital therefore has some freedom in how it operationalizes and makes use of patient voice. In the hospitals in our study, surveys are conducted with an average of 1,500 patients per quarter. The survey is composed of about 10 questions and covers items such as communication with doctors and nurses, flow of information, as well as more hotel-like components of a hospital visit such as cleanliness, food, and waiting times. Each of these items are rated on a scale from 0 to 100 and in their aggregate, are intended to capture a patient’s satisfaction. One interviewee described that although patients who respond positively can simply “click through” and finish with the entire process in a few minutes, poorer ratings involve more extensive questioning (quality manager, 1). All ratings below a 60 prompt follow-up questions for that item, which should help the patient specify what was unsatisfactory. For example, if a patient provides a low rating for “food,” they will be asked to click whether the food was “too salty,” “too sweet,” “too hot,” or “too cold,” and so forth. A final question asks patients if they would recommend the hospital to friends and family. At the end of the survey, there is a general comments section where patients can write their own feedback. Survey results are delivered directly to the quality management department, which calculates average scores for each survey item. Multiple interviewees discussed how quality management has created a weighted index to account for over and/or under participation of different age and morbidity groups. According to a head quality manager, this kind of weighted index, in combination with a historical data pool (his hospital has been conducting the survey for 3 years), provides a retrospective look at long-term changes in patient satisfaction. When discussing the indexed survey results, this quality manager indicated that the hospital “can verify […] a nice increase [in patient satisfaction] over the past three years” (quality manager, 1). Trends in patient satisfaction are also tracked over shorter periods of time and are “continuously reflected” (head physician neurology, 1) back to head physicians. In monthly staff meetings, head physicians discuss changes of patients’ satisfaction compared to the last month and last quarter, as well as how satisfaction has been shifting in comparison to the last year. According to those present, these discussions usually revolve around survey items most relevant to medical staff, such as communication with doctors and nurses, or flow of information. Managers described how this kind of trend information also serves as the basis for ad hoc discussions between management and individual physicians. In cases when survey results are poor, managers talk over satisfaction measures with doctors in order to “support [them] with data” (business manager, 1.1), or establish a “mutual goal for improving results” (business manager, 1.2). Yet another way patient satisfaction is reflected back to medical staff is through departmental rankings. Designed to approximate patients’ overall satisfaction with a department, the quality management department calculates rankings by taking the total average of the individually averaged values for all survey items (head physician, cardiology 2). Rankings are released for the entire hospital every quarter, allowing all departments to see how the others are performing on their patient surveys. According to management staff, the regular publication of rankings is explicitly aimed at sparking an internal competition among different hospital units. According to one quality manager, this strategy works noticeably well in improving overall satisfaction numbers because, as he put it, “who wants to be last?” (quality manager, 1). 4.1.2 From management objects to organizational usefulness In the section above, we saw how patient voice is translated into satisfaction scores (weighted indexes) and departmental rankings. In this first step of translation, patient voice is abstracted from its source and transformed into different numerical representations. Many of our respondents perceived these metrics as important for getting to know how patients experienced service provision. At the same time, survey results were implicated in internal accountability— trends were discussed in monthly staff meetings to see where physicians could “do better” with patients (head physician cardiology, 1), whereas rankings were used to entice the medical staff into self-correcting poor satisfaction metrics. However, the numerical outputs of surveys were not only used as a way to structure internal control. Survey metrics were also reflected upon by management actors as useful tools for addressing other organizational goals. After 408 REILLEY ET AL. being formatted to organizational activity, patient voice became a resource for hospitals seeking to act out their own vested interests in satisfying the demands of various external stakeholders. For example, many interviewees suggested that survey metrics were valuable for constructing a comprehensive image of hospital quality. Although managers and medical staff admitted that quality is a difficult concept to define, most agreed that judging quality is not only about medical outcomes, but also “the entire experience as a whole, including the communication, the information flow, […] the hotel services, (quality manager, 1). We found that in multiple hospitals, managers tend to place focus on survey metrics as a gauge for how the organization is performing. According to one quality manager, “data on patient satisfaction is something we work with a lot right now, because we don’t even belong to the best 25% [of hospitals in our region]” (quality manager, 2); in other instances, patient satisfaction was viewed as an “indicator […] for seeing how we stand compared to other clinics” (strategic manager, 2). Thus, patient voice, when reduced to a quantitative form, helps approximate a picture of quality that not only facilitates internal comparisons of hospital units and discussions of shifting trends, but also allows managers to assess, monitor, and compare their organization as a user-oriented entity. Survey metrics were also viewed as important for gaining financial leverage in a competitive market for service delivery. In Germany, patients are free to choose where they receive care, and in recent years, many hospitals have been confronted with pressure to compete with one another based on quality metrics (Reilley & Scheytt, 2019). According to interviewees, the prospect of performing well on patient surveys (e.g., procuring a high satisfaction rate and high number of “further recommendations”) is presumed to have an effect on a hospital’s ability to attract and maintain patients. Following this line of thinking, business managers were enthusiastic about patient surveys as a mode of investment into the future: “you have to continue [patient surveys] over several years in hopes of obtaining more patients […]” (business director, 1). Some interviewees assumed that by collecting and responding to patient feedback systematically, the quality of care could improve and consequently help attract new and more lucrative patient groups, such as the privately insured. In this sense, satisfaction metrics were not only instrumental in coordinating day-to-day activity, but were also viewed as tools for enacting a broader strategy to increase profits (cf. Vaivio, 1999). Finally, survey metrics were seen as a way for hospitals to enact compliance. All registered hospitals are required to utilize a “patient-oriented” quality management system and a patient survey. Every 3 years, national and regional quality assurance agencies certify quality management systems, checking whether hospitals actually carry out surveys on a regular basis. This represents a rather common example of an audit in which regulators are not interested in primary activities but systems of control (Power, 1996). With regard to the certification process, one quality manager admitted that “if I cannot show that [surveys are completed regularly] every three years, I have a problem” (quality manager, 1). If hospitals are not able to prove that patient surveys have been completed, they may risk losing their system certification, and as a result, lose the right to be registered in the insurance system. Conducting patient surveys thus becomes one part of maintaining the legal right to perform medical treatment. Patient surveys are thus viewed not just a means of enacting forms of internal accountability, but are also used to enact compliance by managers who see themselves as subjects of pervasive auditing arrangements (Power, 1996, p. 4). 4.2 Prisons 4.2.1 From voice to management objects For over 30 years, reform initiatives in the German criminal justice sector have revolved around the prospect of “resocializing” prisoners. In order to foster the participation of prisoners in the organization of prison life, all prisons have been required by German law to form special interest groups, that is, prisoner unions.1When faced with the task of setting up prisoner unions, prison facilities are afforded significant flexibility. Still, as all prisons within a single state answer to the Ministry of Justice and thereby follow the same rules, there is a large degree of homogeneity in how prisoner unions are organized across Germany. REILLEY ET AL.415 6CONCLUSION In conclusion, we want to reflect on two points that we find relevant for further exploration. First, our study examined how user voices are translated into something managers perceive as useful. Although we situated our research within the broader critical literature about how organizations use accounting information, we have by no means fully explored the broader social implications for how organizations account for user voice. Pressure to account for performance through end users is often justified by governments and organizations around the globe as a way to “get closer” to citizens, or afford individuals a view and a voice (Osborne & Gaebler, 1992). Yet, user voice is not merely viewed by managers as a means of getting to know how the user is doing; much more, user voice is made into an object to manage; it is formatted into a source of information for legitimating and better positioning the organization (Ansari & Euske, 1987; Brignall & Modell, 2000; Fountain, 2001; Power, 2007). An organizational perspective of what constitutes a user as useful is rather narrow and raises wider questions about the appropriateness of using the views of (vulnerable) people to aid or justify organizational behavior. Reform ideas targeted at user empowerment or participation actually revolve around organizational interests, rather than the opinions and experiences of individual service users. We believe it is important to further engage with a critical assessment of how organizations deal with voice and whether the managerialist frameworks they often employ can actually empower users. Second, we welcome further work on how accounting practices de facto constrain the voices and opinions of individuals (Pflueger, 2016). As discussed above, narrative forms of accounting shape how translations unfold by limiting how service users express themselves; they filter what information is ultimately fed back into organizational decisionmaking. Practices of list making and protocoling certainly influence how user opinions, experiences, and desires are expressed and embedded into organizational activity (Power, 2015). Thus, regardless of whether or not quantification is involved, all practices that attempt to make the ephemeral voice something concrete have the potential to shape the ways in which organizations describe and relate to service users. For instance, in prisons, voice was filtered and constrained through wish lists—prison administrators were highly selective about what was included on wish lists and worked to refine input into an “appropriate” form. Such lists were constructed in such a way that managers could later use them to leverage financial resources, thus turning prisoner voice into an economic bargaining chip. This is just one example of how accounting practices that generate data from and about users do not need to be quantitative in order to affect how organizations comprehend users. Going forward, we should ask how alternative forms of accounting practice and organizational self-concern shape concrete structures in service delivery, and to what extent these phenomena are actually compatible with the ideal of user orientation. ACKNOWLEDGMENTS The funding underlying this article has been provided by the Deutsche Forschungsgemeinschaft (DFG) (Project No. 627097) under the Open Research Area Scheme (Project Title: QUAD—Quantification, Administrative Capacity and Democracy). Earlier versions of this paper were presented at the 2018 New Public Sector seminar in Edinburgh. We would like to thank all of the participants of that seminar, especially its organizers Irvine Lapsley, Peter Miller, and Illeana Steccolini, as well as our paper’s discussant, Charlotta Levay. For their valuable feedback, we would also like to thank our colleagues in Hamburg, Nadine Gerhardt, Jaromir Junne, Michael Lust, Claudia Meister-Scheytt, and Tobias Scheytt. We would like to thank the two anonymous reviewers for their encouraging comments and helping us improve this paper. Finally, we are especially grateful to all of our interviewees, without whom this study would not be possible. ENDNOTES 1In German, these prison unions are called “Interessenvertretung der Gefangenen” or “Gefangenenmitverantwortung,” and are akin to prisoner interest groups in other countries such as the United Kingdom. We chose a term suggested by one of our interviewees to denote the design and role of these groups specific to Germany, namely, “prisoner union” (Controller, 2.1, B). 416 REILLEY ET AL. DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions. CONFLICT OF INTEREST The authors declare no conflict of interest. ORCID Jacob Reilley https://orcid.org/0000-0002-5587-9388 Nathalie Iloga Balep https://orcid.org/0000-0002-5889-8859 REFERENCES Alvesson, M., & Kärreman, D. (2011). Qualitative research and theory development: Mystery as a method. London, UK: Sage Publications. Andon, P., Baxter, J., & Chua, W. F. (2015). Accounting for stakeholders and making accounting useful. Journal of Management Studies,52(7), 986–1002. https://doi.org/10.1111/joms.12142 Ansari, S., & Euske, K. J. (1987). Rational, rationalizing, and reifying uses of accounting data in organizations. Accounting, Organizations and Society,12(6), 549–570. https://doi.org/10.1016/0361-3682(87)90008-0 Arnaboldi, M., & Azzone, G. (2010). Constructing performance measurement in the public sector. Critical Perspectives on Accounting,21(4), 266–282. https://doi.org/10.1016/j.cpa.2010.01.016 Arnaboldi, M., Lapsley, I., & Dal Molin, M. (2016). Modernizing public services: Subtle interplays of politics and management. Journal of Accounting & Organizational Change,12(4), 547–567. https://doi.org/10.1108/MRR-09-2015-0216 Blank, F. (2009). When “choice” and “choice” are not the same: Institutional frameworks of choice in the German welfare system. Social Policy and Administration,43(6), 585–600. https://doi.org/10.1111/j.1467-9515.2009.00682.x Borchers, U., & Evans, M. (2011). The user oriented hospital—Chances and challenges for the healthcare industry. Zeitschrift Für Evidenz, Fortbildung Und Qualität Im Gesundheitswesen,105(8), 616–623. https://doi.org/10.1016/j.zefq.2011.07.019 Boyce, G. (2000). Valuing customers and loyalty: The rhetoric of customer focus versus the reality of alienation and exclusion of (devalued) customers. Critical Perspectives on Accounting,11(6), 649–689. https://doi.org/10.1006/cpac.2000.0408 Brignall, S., & Modell, S. (2000). An institutional perspective on performance measurement and management in the ‘new public sector.’ Management Accounting Research,11, 281–306. https://doi.org/10.1006/mare.2000.0136 Brorström, S. (2018). How numbers of the future are shaping today: The role of forecasts and calculations in public sector strategic thinking. Financial Accountability & Management,34(1), 17–29. https://doi.org/10.1111/faam.12133 Brunsson, N. (2006). Mechanisms of Hope. Oxfordshire, UK: Copenhagen Business School Press. Burchell, S., Clubb, C., Hopwood, A., Hughes, J., & Nahapiet, J. (1980). The roles of accounting in organizations and society. Accounting, Organizations and Society,5(1), 5–27. Chapman, C. S., Cooper, D. J., & Miller, P. B. (Eds.). (2009). Accounting, organizations, and institutions. Oxford, UK: Oxford University Press. Christensen, M. (2004). Accounting by words not numbers: The handmaiden of power in the academy. Critical Perspectives on Accounting,15(4–5), 485–512. https://doi.org/10.1016/S1045-2354(03)00058-3 Christensen, M., Newberry, S., & Potter, B. N. (2018). Enabling global accounting change: Epistemic communities and the creation of a ‘more business-like’ public sector. Critical Perspectives on Accounting,58, 53–76. https://doi.org/10.1016/j.cpa.2018.04.006 Czarniawska, B. (2000). Organizational translations: From worlds to words and numbers—and back. In H. Kalthoff, R. Rottenburg, & H.-J. Wagner (Eds.), Facts and figures: Economic representations and practices (pp. 117–142). Marburg, Germany: Metropolis. Czarniawska, B. (2010). Translation impossible? Accounting for a city project. Accounting, Auditing & Accountability Journal, 23(3), 420–437. https://doi.org/10.1108/MRR-09-2015-0216 Czarniawska, B., & Joerges, B. (1995). Winds of organizational change: How ideas translate into objects and actions. Research in the Sociology of Organizations,13, 171–209. Czarniawska, B., & Mouritsen, J. (2009). What is the object of management? How management technologies help to create manageable objects. In C. Chapman, D. J. Cooper, & P. B. Miller (Eds.), Accounting, organizations and institutions. Essays in honour of Anthony Hopwood (pp. 157–174). Oxford, UK: Oxford University Press. REILLEY ET AL.417 Damgaard, B., & Lewis, J. M. (2014). Accountability and citizen participation. In M. Bovens, R. E. Goodin, & T. Schillemans (Eds.), The Oxford handbook of public accountability (pp. 258–272). Oxford, UK: Oxford University Press. Eisenhardt, K. M., & Graebner, M. E. (2007). Theory building from cases: Opportunities and challenges. Academy of Management Journal,50(1), 25–32. https://doi.org/10.5465/AMJ.2007.24160888 Ewert, B. (2011). When choice becomes a duty and voice is limited: Healthcare consumerism in Germany. Central European Journal of Public Policy,5(1), 52–75. Feest, J., Lesting, W., & Lindemann, M. (Eds.). (2017). Strafvollzugsgesetze Kommentar (AK-StVollzG) (7th ed.). Köln, Germany: Carl Heymanns Verlag. Feldman, M. S., & March, J. G. (1981). Information in organizations as signal and symbol. Administrative Science Quarterly,26(2), 171–186. https://doi.org/10.1016/0044-8486(86)90216-4 Fotaki, M. (2011). Towards developing new partnerships in public services: Users as consumers, citizens and/or coproducers in health and social care in England and Sweden. Public Administration,89(3), 933–955. https://doi. org/10.1111/j.1467-9299.2010.01879.x Fountain, J. E. (2001). Paradoxes of public sector customer service. Governance: An International Journal of Policy and Administration,14(1), 55–73. https://doi.org/10.1111/0952-1895.00151 Garfinkel, H. (1967). “Good” organizational reasons for “bad” clinic records. In H. Garfinkel (Ed.), Studies in ethnomethodology (pp. 186–207). Englewood Cliffs, New Jersey: Prentice Hall, Inc. Gerring, J. (2007). Case study research. Principles and practices. Cambridge, UK: Cambridge University Press. https://doi.org/10.1192/bjp.111.479.1009-a Hasenfeld, Y. (2010). Human services as complex organizations (2nd ed.). London, UK: Sage Publications. Hood, C. (1991). A public management for all seasons? Public Administration,69, 3–19. Hopwood, A. G. (1994). Accounting and the pursuit of efficiency. In D. McKevitt & A. Lawton (Eds.), Public sector management: Theory, critique and practice (pp. 145–159). London, UK: Sage Publications. Hyndman, N., & Lapsley, I. (2016). New public management: The story continues. Financial Accountability & Management,32(4), 385–408. Iloga Balep, N., & Huber, C. (2017). Quantification times 16: When decentralization stands in the way of markets. Risk & Regulation, Winter, (34), 17–18. Jick, T. D. (1979). mixing qualitative and quantitative methods: Triangulation in action. Administrative Science Quarterly,24(4), 602–611. https://doi.org/10.2307/2392366 Jonsen, K., & Jehn, K. A. (2009). Using triangulation to validate themes in qualitative studies. Qualitative Research in Organizations and Management,4(2), 123–150. https://doi.org/10.1108/17465640910978391 Jordan, S., & Messner, M. (2012). Enabling control and the problem of incomplete performance indicators. Accounting, Organizations and Society,37(8), 544–564. https://doi.org/10.1016/j.aos.2012.08.002 Köppe, S., Ewert, B., & Blank, F. (2016). Welfare User Roles in a conservative welfare state. Are Germans citizens, consumers or co-producers? Journal of International and Comparative Social Policy,32(1), 1–16. https://doi.org/10.1680/geot.2008.T.003 Lapsley, I. (2008). The NPM agenda: Back to the future. Financial Accountability & Management,24(1), 77–96. https://doi.org/10.1111/j.1468-0408.2008.00444.x Mantere, S., & Ketokivi, M. A. (2013). Reasoning in organization science. Academy of Management Review,38(1), 70–89. Miller, P. (1996). Dilemmas of accountability: The limits of accounting. In P. Hirst & S. Khilnani (Eds.), Reinventing democracy (pp. 57–69). Oxford, UK: Blackwell Publishers. Miller, P., & Power, M. (2013). Accounting, organizing, and economizing: Connecting accounting research and organization theory. The Academy of Management Annals,7(1), 557–605. https://doi.org/10.1080/19416520.2013.783668 Modell, S. (2001). Performance measurement and institutional processes: A study of managerial responses to public sector reform. Management Accounting Research,12(4), 437–464. https://doi.org/10.1006/mare.2001.0164 Mouritsen, J. (1997). Marginalizing the customer: Customer orientation, quality and accounting performance. Scandinavian Journal of Management,13(1), 5–18. https://doi.org/10.1016/S0956-5221(96)00026-7 Mouritsen, J., Hansen, A., & Hansen, C. O. (2009). Short and long translations: Management accounting calculations and innovation management. Accounting Organizations and Society,34, 738–754. Munro, R. (2001). Calling for accounts: Numbers, monsters and membership. Sociological Review,49(4), 473–493. https://doi.org/10.1111/1467-954X.00343 Newman, J., & Clarke, J. (2009). Publics, politics, and power: Remaking the public in public services. London, UK: Sage Publications. Newman, J., & Kuhlmann, E. (2007). Consumers enter the political stage? The modernization of health care in Britain and Germany. Journal of European Social Policy,17(2), 99–111. https://doi.org/10.1177/0958928707075191 O’Leary, T., & Miller, P. (1987). Accounting and the construction of the governable person. Accounting, Organizations and Society, 12(3), 235–265. Ogden, S. G. (1997). Accounting for organizational performance: The construction of the customer in the privatized water industry. Accounting, Organizations and Society,22(6), 529–556. https://doi.org/10.1016/S0361-3682(96)00027-X 418 REILLEY ET AL. Osborne, D., & Gaebler, T. (1992). Reinventing government. How the entrepreneurial spirit is transforming the public sector.New York, NY: Penguin Books. Pfeffer, N., & Coote, A. (1991). Is quality good for you? A critical review of quality assurance in welfare services. London, UK: Institute for Public Policy Research. Pflueger, D. (2016). Knowing patients: The customer survey and the changing margins of accounting in healthcare. Accounting, Organizations and Society,53, 17–33. https://doi.org/10.1016/j.aos.2016.08.002 Porter, M. E., & Guth, C. (2012). Redefining German health care. Moving to a value-based system. Heidelberg, Germany: Springer. Power, M. (1992). After calculation? Reflection on critique of economic reason by André Gorz. Accounting, Organizations and Society,17(5), 477–499. https://doi.org/10.1016/0361-3682(92)90043-R Power, M. (1996). The audit explosion. London, UK: Demos. Power, M. (2005). The theory of the audit explosion. In E. Ferlie, L. E. Lynn, & C. Pollitt (Eds.), The Oxford handbook of public management (pp. 326–344). Oxford, UK: Oxford University Press. Power, M. (2007). Organized uncertainty. Designing a world of risk management. Oxford, UK: Oxford University Press. Power, M. (2015). How accounting begins: Object formation and the creation of infrastructure. Accounting, Organizations and Society,47, 43–55. Reilley, J., & Scheytt, T. (2019). A calculative infrastructure in the making: The emergence of a multi-layered complex for governing healthcare. Research in the Sociology of Organizations,62, 43–68. https://doi.org/ 10.1108/S0733-558X20190000062004 Richardson, A. (1983). Participation. London, UK: Routledge and Kegan Paul Plc. Robson, K. (1992). Accounting numbers as “inscription”: Action at a distance and the development of accounting. Accounting, Organizations and Society,17(7), 685–708. https://doi.org/10.1016/0361-3682(92)90019-O Sauder, M., & Espeland, W. N. (2009). The discipline of rankings: Tight coupling and organizational change. American Sociological Review,74, 63–82. https://doi.org/10.1177/000312240907400104 Simmons, R., Birchall, J., & Prout, A. (2012). User involvement in public services: “Choice about voice.” Public Policy and Administration,27(1), 3–29. https://doi.org/10.1177/0952076710384903 Simmons, R., & Brennan, C. (2017). User voice and complaints as drivers of innovation in public services. Public Management Review,19(8), 1085–1104. https://doi.org/10.1080/14719037.2016.1257061 Steccolini, I. (2019). Accounting and the post-new public management: Re-considering publicness in accounting research. Accounting, Auditing & Accountability Journal,32(1), 255–279. https://doi.org/10.1108/09574090910954864 Timmermans, S., & Almeling, R. (2009). Objectification, standardization, and commodification in health care: A conceptual readjustment. Social Science and Medicine,69(1), 21–27. https://doi.org/10.1016/j.socscimed.2009.04.020 Vaivio, J. (1999). Examining “the quantified customer. Accounting, Organizations and Society,24(8), 689–715. https://doi.org/10.1016/S0361-3682(99)00008-2 Vigoda, E. (2002). From responsiveness to collaboration: Governance, citizens, and the next generation of public administration. Public Administration Review,62(5), 527–540. Watkins, A. L., & Arrington, C. E. (2007). Accounting, new public management and American politics: Theoretical insights into the national performance review. Critical Perspectives on Accounting,18(1), 33–58. https://doi.org/ 10.1016/j.cpa.2005.02.003 Wisniewski, M. (2001). Using SERVQUAL to assess customer satisfaction with public sector services. Managing Service Quality: An International Journal,11(6), 380–388. https://doi.org/10.1108/EUM0000000006279 Yin, R. K. (2014). Case study research. Design and methods (5th ed.). London, UK: Sage Publications. How to cite this article: Reilley J, Balep NI, Huber C. Making the user useful? How translation processes managerialize voice in public organizations. Financial Acc & Man. 2020;36:401–419. https://doi.org/10.1111/ faam.12249 REILLEY ET AL.419 TABLE A1 An overview of how many interviews were conducted and with which personnel Hospitals Number of interviews Business managers, strategic directors, and quality managers 7 Medical directors and head physicians 11 Assistant physicians 3 Total number of interviews: 21 Prisons Number of interviews Prison directors and controllers 16 Heads of department 21 Correctional officers 4 Total number of interviews: 41 APPENDIX