Unpacking hospital accreditation systems through a governmentality lens
研究以西班牙公立医院为例，分析强制认证体系如何通过会计、测量和审计等实践，将医院活动变得可见、可比和可远程治理，同时重塑专业人员的主体性。
This study examines how accounting and management control practices embedded in a mandated hospital accreditation system govern organisational conduct in public healthcare. Drawing on a governmentality perspective, it analyses how recurring accreditation cycles mobilise power and knowledge in a Spanish public hospital. The findings show that the accreditation system has shifted from a rule-based compliance logic towards a performance-driven calculative regime centred on accounting, measurement and audit. Through benchmarking, standardisation and continuous evaluation, this accreditation renders hospital activities visible, comparable and governable from a distance, while encouraging internalised self-regulation. In doing so, it reframes political and professional disputes as technical problems of improvement and performance, thereby depoliticising key governance choices. The study also shows how the accreditation system reshapes professional subjectivities by combining managerial and clinical rationalities, promoting autonomy in form while intensifying control in practice. By conceptualising the accreditation system as an accounting-centred governance mechanism, the paper contributes to debates on how accountability reforms in public services reorganise visibility, evaluation and professional conduct, while narrowing interpretive flexibility and democratic deliberation in healthcare governance.