Translating visions of transparency and quality development: the transformation of clinical databases in the Danish hospital field

One of the most significant developments in the quest for quality, transparency, and accountability in healthcare is the construction and the implementation of indicator-based technologies. In Denmark, this development has been relatively pronounced, and based on an extensive document study supplemented by qualitative interviews, this paper articulates a policy history of the clinical databases for quality from the early 1990s to the present. First, the paper outlines how, in the early 1990s, the National Board of Health and representatives from the medical profession place the clinical databases on the quality agenda in healthcare. Second, the paper shows that, in spite of an initial alignment between governmental and professional interests, the establishment of national clinical databases for quality turns out to be a difficult enterprise. Third, the paper elaborates how the public authorities respond to the challenges by re-designing the governance framework for the databases. The transformations are characterized by increased centralization, standardization, specialization and regulative pressure. Finally, it is pointed out that although the course of events does constitute an increased institutionalization of the clinical databases, large variations exist and several databases have not yet realized the ambitions of transparency and quality improvement.