readings

Government Information Quarterly 24 (2007) 165–185

Publishing public performance results on the Internet

Do stakeholders use the Internet to hold Dutch

public service organizations to account?

Albert Jacob Meijer 4

Utrecht School of Governance, Bijlhouwerstraat 6, 3511 ZC Utrecht, The Netherlands

Available online 26 July 2006

Abstract

This paper analyzes the relation between publishing public performance results on the Internet,

stakeholder accountability, and the effectiveness and legitimacy of Dutch public service organizations.

The empirical research focuses on Web sites with performance results of schools and hospitals. These

results are published on the Internet by dthird partiesT (government organizations, associations of public service organizations, and newspapers). Publications of performance results stimulate schools

and hospitals to score better on performance indicators because they feel the dpublic eyesT on them. However, the risk of a dperformance paradoxT and adverse effects is great since strategic behavior may lead to higher scores but not improve the effectiveness of these organizations. The research provides

moderate support for negative effects on the legitimacy of schools and hospitals which may be

attributed to the sole use of the Internet as a medium for access to information and negligence of its

communicative potential.

D 2006 Elsevier Inc. All rights reserved.

Keywords: Stakeholders; Accountability; Internet; Performance indicators; Education; Healthcare

0740-624X/$

doi:10.1016/j.g

4 Fax: +31 3

E-mail add

- see front matter D 2006 Elsevier Inc. All rights reserved.

iq.2006.01.014

0 2537200.

ress: [email protected].

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185166

1. Introduction

In many countries, performance results of public service organizations are published on the

Internet to stimulate these organizations to improve their performance. Performance results

are measurements of the outputs of public service organizations such as the student success

rates for schools and the number of post-surgery infections in hospitals. Citizens are assumed

to get more value for money when they can compare public service organizations and choose

the best one on the basis of an evaluation of performance. The effects of performance

measurements have predominantly been analyzed from the perspective of a change from

government control to market steering.(Pollit & Bouckaert, 2000, pp. 172–178) This paper

takes another perspective: It evaluates the effects of public performance measurements from

an accountability perspective with a focus on the role of information.

Public service organizations need to account for their policies and performance to a variety

of stakeholders. This paper analyzes the relation between publishing performance results on

the Internet, the new forms of accountability, and the effectiveness and legitimacy of public

service organizations. The body of literature on new forms of accountability is steadily

growing. Modern public service organizations increasingly deal with dynamic, informal, and

non-institutionalized forms of accountability.(Considine, 2002; Goetz & Jenkins, 2001;

Mulgan, 2000) Hierarchical arrangements, such as inspection services, formal audits, direct

supervision, are being supplemented with new, less formalized forms of accountability

(sometimes called dhorizontalT or ddownwardT accountability). Many public service organizations account for their actions to client panels or directly to individual citizens

through public annual reports.

Publications on new forms of accountability generally do not pay specific attention to

technological developments. The growing importance of the Internet, however, adds a new

dimension to these non-institutionalized forms of accountability. This medium creates an new

dinformation spaceT that influences relations between actors in the public sector. The Internet could enable citizens to get information about the functioning of public service organizations,

interact with these organizations, and ask them to explain and justify their policies and

performance. One can argue that the Internet creates opportunities for direct accountability to

citizens (Meijer, 2003; Raab, 1997; Wong & Welch, 2004). Furthermore, also other

stakeholders – financiers, employees, clients – can call public service organizations to

account on the basis of public information on the Internet.

These opportunities for public accountability through the Internet have been mentioned for

some time but no research indicates whether citizens and other stakeholders actually use of

the information. They are assumed to either choose an organization on performance results or

complain when the results are poor but the scientific literature provides little information

about the actual use by citizens and stakeholders. Furthermore, the literature does not indicate

whether new forms of Internet-enabled stakeholder accountability actually influence policies

and behavior of public service organizations.

The first goal of this paper is to enhance our empirical understanding of Internet facilitated

stakeholder accountability practices. The paper describes the availability of information on

the Internet, the use citizens and stakeholders make of the information and thus creates

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185 167

insights in these new and evolving practices of public accountability. The second goal is to

evaluate the consequences of these new forms of accountability. The paper explores how

public service organizations react when they are asked to account for their performance and

addresses the relation between public accountability through the Internet and the legitimacy

and effectiveness of public service organizations. These two goals led to the following

research question: What are the effects of stakeholder accountability – through the Internet –

on public service organizations?

This paper first presents a theoretical framework for studying public accountability through

the Internet. This framework builds upon conceptualizations of accountability, Stakeholder

Theory, and studies into public information systems. Second, the research design and the

empirical findings in these sectors are presented. The research has a qualitative and

explorative character and analyzes public sector organizations in education and health care in

the Netherlands to evaluate accountability through the Internet in these two sectors. The

empirical sections contain brief descriptions of policy sector and focus on effects of the

Internet on stakeholder accountability. This paper ends with (preliminary) conclusions and

reflections on stakeholder accountability via the Internet. The key argument is that

stakeholders do not ask public service organizations to account for their performance, but

the fact that they could call them to account stimulates public service organizations change

their policies and behavior: dPublic eyesT stimulate better performance.

2. Stakeholder accountability

In its most fundamental sense, accountability refers to answerability to someone for

expected performance (Romzek & Ingraham, 2000). Accountability involves an actor with a

duty to render an account and another actor with the power to judge and impose sanctions

(White & Hollingsworth, 1999). dThird partiesT such as auditors and inspectorates facilitate accountability by providing neutral information about an actor’s policies, actions, and

performance. Theories of public accountability mostly focus on formal, institutionalized, and

often hierarchical forms of accountability (Bovens, 1998; Day & Klein, 1987; Romzek &

Dubnick, 1987). A comparison with dtraditional accountabilityT can help to explain the concept of stakeholder accountability.

Traditional forms of accountability concern core institutions with legal tasks and powers

that play a key role in providing checks and balances for democratic governments. Central to

these forms of accountability is the notion of accountability to formal bodies or officials.

Public sector organizations have to account for their policies and spending of public money to

government officials. These officials in their turn account to political appointees and these

account to representatives of the people. In addition, public service organizations also account

for their actions to legal institutions such as Ombudsmen and (administrative) judges.

Auditors and inspectorates facilitate formal accountability processes by providing neutral

information about public service organizations’ performance.

New forms of accountability start from the notion of stakeholders as accountability forums.

The term stakeholder was originally used in business administration to express that

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185168

businesses do (or should) not only serve shareholders. Stakeholder Theory (Donaldson &

Preston, 1995) consists of normative assumptions (organizations have moral and ethical

duties to know and respect the interests of their stakeholders), descriptive assumptions (the

operational environment of organizations can be described by identifying stakeholders and

their objectives and how these relate to the organization), and instrumental assumptions

(suitable strategies should be deployed to align the different interests of stakeholders and

to meet potential conflicts caused by diverging conflicts). Stakeholders such as financiers,

employees (prospective), and clients are also interested in the performance of public

service organizations. Translated to the public sector, stakeholders are those who interact

with or have a stake in the public organization (cf. Ref. (Walker & Marr, 2001, p. ix).

Atkinson, Waterhouse, Wells, 1997 define two groups of stakeholders: environmental

(customers, owners, and the community) and process (employees and suppliers). These

stakeholders can be individuals but also organized groups such as a union of government

employees.

Increasingly, stakeholders call public service organizations to account (Demortain, 2004;

Prabhakar, 2004). They can use either information provided by the public service

organization or information provided by dthird partiesT to evaluate a public service organization’s performance. Media are an important provider of information but auditors

and inspectorates also provide information to stakeholders. Citizens demand special

attention because they are the prime target group for policies. In rhetoric, public

accountability is first and foremost accountability to citizens. This idea has been described

the so-called New Public Service (Denhardt & Vinzant, 2000): Public sector organizations

should be organized in such a way that public servants are responsive to citizens. As this

paper will show, however, other stakeholders may have more influence on public service

organizations. The simplification of direct accountability as accountability to citizens is

inadequate. Attention for other stakeholders is required to understand new forms of

accountability.

Stakeholder accountability differs from traditional forms of accountability in the following

aspects:

– No formal information provision. Accountability forums require information to reconstruct

performance. Institutionalized forums such as Parliament, Ombudsman, and judges rely on

rules for the provision of information but these legal obligations generally do not exist in

stakeholder accountability. Stakeholders may benefit from freedom of information acts but

mainly rely on public information. Public service organizations and dthird partiesT publish performance results in annual reports and on their Web sites. A difference with

institutionalized forms of accountability is that not only formalized dthird partiesT such as auditors and inspectorates provide information about performance but also informal

dthird partiesT such as the media and interest groups. – No fixed format for debate. Debates between public service organizations and

accountability forums are needed to evaluate and interpret performance and establish

criteria for acceptable performance. Political and legal forms of accountability have

explicit rules for debating the performance of public service organizations. These rules

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185 169

usually entail opportunities for these organizations to explain and justify their policies and

performance. There is no fixed format for debate about policies and performance of public

service organizations with stakeholders. Much of the debate takes place in the media and

those debates often do not provide fair opportunities for redress.

– No formal sanctions tied to stakeholder judgments. Forums can impose sanctions if they

evaluate performance negatively. Parliament can demand that a minister steps down and

judges can fine public service organizations or force them to take another decision.

Stakeholders do not have these formal sanctions and therefore use informal ones. The type

of sanction depends on the stakeholder. Citizens can use dexitT and dvoiceT as sanctions Hirschman, 1970. They can choose to leave the organization – for example, choose to go

to another school – or complain (publicly) about performance. Financiers can use financial

sanctions: A medical health insurance company, for example, might decide to give less

money to a hospital. The media can use publicity as a sanction. In the information age,

reputation is extremely important. Negative publicity might damage the image of an

organization as is therefore an important sanction.

The differences between stakeholder accountability and traditional forms of accountability

are summarized in Table 1.

Stakeholder accountability should not primarily be regarded as a substitute for traditional

forms of accountability but rather as an addition. Historically, new forms of accountability

have been added to the political–administrative system with the growing complexity of

government. Stakeholder accountability seems to be a contemporary answer to the present

complexity of the public sector. It is introduced as a new form of accountability to strengthen

the public sector. One could argue that stakeholder accountability also challenges and even

undermines other forms of accountability. Effects on other forms of accountability, however,

are beyond the scope of this paper.

Stakeholder accountability does not directly affect the functioning of public service

organizations. In various ways, stakeholders’ sanctions are signals to public service

organizations to indicate that they want them to change. Deutsch’ (Deutsch, 1966) theory

of the dnerves of governmentT highlights how these signals can be picked up by organizations and lead to changes. dReceptorsT pick up information from the environment and deffectorsT implement changes when they have the motivation and capacities to change public service

Table 1

Comparing traditional and stakeholder accountability

Traditional accountability Stakeholder accountability

Information provision Forum can demand

disclosure of information

Forum mostly relies on

public information

Format for debate Rules warrant debate on

interpretations and justifications

dFree floating debateT without formal opportunities

for redress

Type of sanctions Formal sanctions such as

fines and political measures

Variety of informal sanctions

(exit, voice, finances, publicity)

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185170

organizations. When either receptors or effectors function well, stakeholder accountability

will lead to changes in public service organizations. This leads to the question whether these

changes will improve the effectiveness and legitimacy of the public sector that will be dealt

with in the next section.

The conceptual framework for studying the effects of stakeholder accountability through

the Internet on public service organizations is summarized in Fig. 1. The figure consists of

three columns: the left column concerns the publishing of information by either public

service organizations themselves or by dthird partiesT, the central column contains the behavior of stakeholders, and the right column refers to the actions of public service

organizations.

This model depicts a chain of activities which may eventually lead to a change in the

behavior of public service organizations. This chain is based on assumptions an expectations

in the literature on stakeholder accountability. Whether this chain of activities actually occurs

and whether it occurs in this sequence was to be investigated in empirical research. Before the

Fig. 1. Conceptual model.

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185 171

research is presented, the role of the Internet in stakeholder accountability and the effects of

changes in public service organizations’ behavior will be discussed.

3. Internet: chances and risks for stakeholder accountability

Stakeholder accountability does not depend on the Internet but the introduction of the

Internet has created many new opportunities for stakeholder accountability. The Internet

increases the transparency of the public sector (Meijer, 2003). Before the introduction of the

Internet, stakeholders found it much more difficult to get access to information about the

performance of public service organizations. Now information about performance can easily

be accessed through the Internet. Additionally, the Internet has created an incentive for public

service organizations to be more open and publish information about their performance. And

the Internet also makes it much easier to create canals for interaction between stakeholders

and public service organizations. Techno-optimists stress that all these new opportunities will

bring us a better public sector (Brin, 1998), techno-pessimists warn for the dark side of

transparency (Bovens, 2003).

Proponents of stakeholder accountability stress that a better informed citizenry holds for a

strong democracy (Barber, 1984). Citizens are more likely to support democratic arrange-

ments when they have knowledge about the public sector. Informal accountability

arrangements can also increase the confidence of stakeholders in the achievements of public

service organizations when they can show policy outputs. Scharpf (1999) has highlighted the

growing importance of output legitimacy: Citizens increasingly judge the legitimacy of the

public sector not only on the basis of input processes such as democratic elections, but also on

the basis of public sector performance. Publicizing performance results of public service

organizations on the Internet could thus increase the output legitimacy of the public sector.

Stakeholder accountability can also increase the detection of failures and therefore improve

the effectiveness of public service organizations (Brin, 1998). Proponents point at the success

of the computer system LINUX (Raymond, 1998). The system code is available to all and

therefore flaws in the code are easily detected. dGiven enough eyeballs, all bugs are shallow,T as hackers say. The same idea may apply to public service organizations. When citizens and

other stakeholders closely follow these organizations on the basis of information on the

Internet, failures in policies may be detected and corrected.

Another chance for increasing the effectiveness concerns the input of stakeholders in

policy development: Stakeholders may use the Internet to react directly on performance

results of public sector organizations. These organizations may get a better understanding of

demands on their organizations and consequently adjust their policies. The cycle of policy

development, implementation and evaluation may thus be improved.

Critics of stakeholder accountability emphasize the risk of ddecouplingT (Power, 1999): there may be a gap between accountability information and actual performance. This will

effectively lead to symbolic accountability processes: Stakeholders will hold public service

organizations to account on the basis of information on the Internet that only highlights

certain aspects and does not provide an accurate overview of performance.

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185172

Another risk mentioned by Power is dpenetrationT: public service organizations may not so much try to perform well as to score high on accountability standards. This may lead to a

dperformance paradoxT or dperverse learningT (Dubnick, 2003; Meyer & Gupta, 1994; van Thiel & Leeuw, 2002): indicators are no longer an adequate measure for performance.

Another risk is that, even though publishing information on the Internet is relatively cheap,

the costs of accountability – gathering and publishing information, debating performance –

will go up dramatically.

’t Hart (2001) has called attention for the risk that increased transparency may lead to an

dinquisition democracyT. Citizens, stakeholders, and especially media may highlight every flaw and every failure of a public organization. Wastes of public money always make good

headlines. Eventually, this unbalanced focus on failures in the public sector may undermine its

legitimacy.

The legitimacy of the public sector may also be damaged when only a select of citizens use

the information on the Internet to call public service organizations to account (Fountain,

2001, p. 64) highlights the risk that some citizens may receive a better service than others and

calls attention for growing inequalities. In the worst case, one could speak of a meritocracy: A

group a high educated citizens will improve their situation, others will stay behind. This issue

is directly connected to the digital divide. Some citizens have Internet access, know how to

use the Internet, and call public service organization to account, others do not.

The literature indicates that stakeholder accountability through the Internet creates both

chances and risks for the effectiveness and legitimacy of public service organizations, which

are summarized in Table 2. These risks and chances are related to three aspects: performance

measurements, stakeholder accountability, and the Internet. The risks concerning effective-

ness are well described in the literature on performance measurement and stakeholder

involvement does not seem to create additional risks. The chances for increasing effectiveness

and legitimacy and the risks concerning legitimacy are not as well described in the literature

on performance measurements and more directly related to involvement of stakeholders.

Performance measurements that would not be made available to stakeholders would not result

in these chances and risks. The Internet does not create additional chances and risks but

should be seen as a driver of transparency because it lowers the costs of making information

available to stakeholders and creates new opportunities for communication between

stakeholders and public service organizations.

Some of these chances and risks are related to those that have been mentioned for

performance management in the public sector (de Bruijn, 2002; van Thiel & Leeuw, 2002). A

Table 2

Chances and risks of stakeholder accountability

Chances Risks

Effectiveness Detection of failures Decoupling

Improved feedback Performance paradox

Rising control costs

Legitimacy Better informed citizenry Inquisition democracy

Higher output legitimacy Meritocracy

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185 173

crucial difference, however, is that most of the literature on performance measurement

focuses on the impact these measurements have on formal relations between public

organizations and their principals. When the results of performance management are

published on the Internet, they are made available to all stakeholders. These stakeholders can

use the information in various ways to call public service organizations to account.

4. Research design

On the basis of the previous discussion, the following specific questions were formulated

to guide the research aimed at getting an empirical understanding of Internet facilitated

stakeholder accountability practices and evaluating its effects:

1. What information concerning public service organization performance is published by

whom in what manner on Web sites?

2. To what extent and how do stakeholders use this information to reconstruct public service

organizations performance?

3. Do stakeholders use the information in debates with other stakeholders and with public

service organizations to interpret and evaluate performance?

4. What kind of sanction do various stakeholders impose if they evaluate performance

negatively?

5. To what extent and in what manner do public service organizations pick up these sanctions

as signals from stakeholders?

6. In what way public service organizations adapt their behavior in reaction to stakeholder

demands?

7. Do changes in public service organizations behavior increase the effectiveness of these

organizations?

8. Do changes in public service organizations behavior increase the legitimacy of these

organizations?

The last two questions are methodologically most complicated because measurements of

effectiveness and legitimacy are always complicated and contested. In this research,

perceptions of effectiveness and legitimacy of both member of public service organizations

and representatives of stakeholders are used as proxies for a qualitative evaluation of changes

in effectiveness and legitimacy.

A broad investigation of Web sites with public service organizations’ performance

results formed the first step in an identification of relevant cases. This broad investigation

was carried out in January 2003 and consisted of following links from a well-known

portal (http://www.rekenschap.nl), interviews with two key informants in the Netherlands,

and general searches directed by newspaper publications of two main Dutch newspapers

(Volkskrant and NRC Handelsblad). This exploration resulted in a list of relevant Web

sites and identification of these Web sites in terms of primary objectives and target

groups.

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185174

The second step consisted of selecting cases from this list. A key concern is this research

was that new accountability practices might still be evolving and therefore there could be

little to be investigated empirically. Two criteria were formulated for the selection of cases:

(1) the Web sites should have received much attention in Dutch media, and (2) the Web sites

should present information that is relevant to citizens. These criteria were formulated to be

sure that the Web sites are known to citizens and stakeholders and, therefore, will receive a

relatively high amount of hits. This means that these practices cannot be seen as stand

practices but rather as forerunners of developments in Internet-enabled stakeholder

accountability. The Web sites that were selected published performance results in the sectors

High School Education and Hospital Health Care. In both sectors, there are several

organizations that present information on performance results on the Internet. This paper

focuses on the Web sites that were considered to be most important in the view of both

stakeholders and public service organizations.

In education and health care, non-governmental organizations receive public money to do

their work. Citizens do not have a direct relation with government officials but communicate

with employees of these non-governmental organizations. Citizens also have the opportunity

to choose between different schools and hospitals. This means that they can use both dexitT – which is defined here rather broadly to include dchoiceT – and dvoiceT as a reaction to a decline in the performance of organizations (Hirschman, 1970). A difference between

education and health care is that citizens generally have a long-term relationship with a school

whereas they may visit different hospitals. One should add that the Netherlands is densely

populated and therefore most citizens have several hospitals within their vicinity. Another

difference concerns the time available for making a choice: In education, there is generally

more time, in health care patients often need to make their choice fast. Additionally, the

situation a patient is in may hamper his capacity for judgment.

The research specifically addressed stakeholder accountability through the Internet. It

focused on high profile Internet applications and did not cover the whole range of

accountability practices. In education Web sites that publish Quality Cards with performance

results of schools were studied, in health care the research focused on Web sites with

information on waiting lists for hospitals. Other accountability practices, for example,

accountability in teacher parent meetings, were only dealt with when they were directly

related to information published on the Internet. The focus on the Internet limits the research

findings: A general exploration of stakeholder accountability would require a broader

perspective and attention for different media.

In each sector, there was information about the performance of public organizations on the

Internet. Data were gathered from March till June 2003 through interviews with

representatives of those public service organizations (the principals of two schools (De Klop

and Sint Gregorius College) and communication managers of two hospitals (Onze Lieve

Vrouwen Gasthuis and Diakonessenhuis) and also with the organizations that published this

information on the Internet (the journalists of two newspapers (Trouw and Algemeen

Dagblad), two senior managers of the School Inspection Service, and two managers of the

National Association of Hospitals). They were asked for information on the use of these Web

sites but generally this information was limited to the amount of hits. Additional data were

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185 175

gathered through interviews with stakeholders to find out whether they use the Internet for

accountability. In education, a representatives was interviewed and through e-mail questions

were asked to a representatives of two parents’ association. In education, representatives of

the and the ministry of health were interviewed and through e-mail questions were asked to

the patients’ association. A secondary analysis of information on choice and voice in

education and healthcare and stakeholder behavior played an important role. The following

material was used for the case study in education: (Dijkstra, Karsten, Veenstra, Visscher

(2001); Dronkers (1999); Hilhorst (2001); Inspectie van het Onderwijs (2002); Onderwijsraad

(1999); Vogels (2002)). And the following material was used for the case study in healthcare:

Kievit (2001); van der Kraan (2001); School (2001); Stoop and Berg (2002a), (2002b); Berg

and Schellekens (2002); Medisch Contact (2002); Pronk (2002); van Everdingen (2003);

Groenwoud and Huijsman (2003); Talma and Pieter (2003) and de Vries (2003).

This aim of this explorative research was to get a better conceptual understanding of the

relation between public information on the Internet, stakeholder accountability practices, and

effects on public service organizations, and therefore the research was qualitative. Testing of

theoretical expectations was outside the scope of this research and will require additional,

quantitative research.

5. Quality Cards in education

In the Netherlands, people are free to choose the school they think is best for their children.

Traditionally, there was a pillarized system with Catholic, Protestant, and public schools and

most people chose the school according to these denominations. Nowadays there are still

Catholic, Protestant, and public schools, but because of the secularized character of the Dutch

society these denominations are not as important as before in school choice. All these schools

are funded with public money and the quality of education is inspected by the national School

Inspection Service (in Dutch, Onderwijsinspectie). Inspectors of the School Inspection

Service visited schools regularly and reported on the results of these inspections to the

schools and to the Minister of Education. Until 1997, these results were not made public and

were not accessible to citizens.

In 1997, a Dutch journalist requested access to databases that contained summaries of these

inspection reports. The minister of Education denied this access but a judge concluded that the

minister did not have strong arguments to support his case. The minister was ordered to grant

access to the results of school inspection and the journalist used these results to compare the

quality of schools and compare schools in different respects. From then on this newspaper –

Trouw – published articles on the quality of schools every year and it also opened a Web site so

that citizens could view this information all year around (http://www.trouw.nl).

The increased transparency led to drastic changes in the School Inspection Service.

The agency decided that it would also publish the results of school inspections itself. The

School Inspection Service even redefined its task and stated that one of its tasks was to

provide citizens with independent and reliable information about the quality of schools.

The School Inspection opened a Web site and first published quantitative information

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185176

concerning the quality of schools – the so-called Quality Cards – in 1998 (http://

www.kwaliteitskaart.nl).

Two dthird partiesT – the newspaper Trouw and the School Inspection Service – provide information to stakeholders. The newspaper could not give me information about the number

of hits on their Web site, but the School Inspection Service indicated that they got about 800

visitors daily in July, August, and September 2004. They also got about 200 questions a

month through the info-mail facility on their Web site. Neither the School Inspection Service

nor the newspaper had information on the character of the visitors to the Web site and the use

of the information. Did parents use the information to choose a school? Or was the

information used by other stakeholders?

Research indicates that information on the quality of school is not very important in the

choice for a school dexitT Hirschman (1970). Sources of information that are used for the choice of schools are presented in Table 3.

An alternative form of use might be that parents use the quantitative information to discuss

the quality of education with teachers and school management (in Hirschman’s (1970)

terminology: dvoiceT). Interviews with school management, however, indicate that parents rarely ask school management questions on the basis of the Quality Cards.

The interviews indicated that the information is used by various other stakeholders. Teachers

and school management view the Quality Cards on the Internet to evaluate how their schools are

doing compared to other schools in the region. Rankings are important and a high ranking is

celebrated. In this respect, the Dutch are not a special case. Empirical research in England

indicates that English teachers and school management also find rankings important (Hilhorst,

2001, p. 84).

An important stakeholder is the media. Local media use the Quality Cards to write articles

on the quality of schools in their region. What is the best school in the region? Negative

publicity can damage the reputation of schools and therefore have an impact on school

choices.

Although the Quality Cards have little influence on school choices, the information on the

Internet does have an impact on school policies. Schools try to improve their rankings and

school management makes an effort to improve the output of the school. However, the

Quality Cards also stimulate forms of strategic behavior. Schools are no longer lenient in their

Table 3

Information used in school choice Vogels (2002) p. 40

Visits to schools 79%

Advice given by primary school 54%

Information provided by other parents 38%

Written information 34%

Articles in newspapers 6%

Quantitative information on the Internet 5%

School Web sites 1%

Other information 17%

No information 2%

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185 177

selection of students, do not follow policies that might improve the quality of education, but

do no result in a higher ranking and might even give students higher grades to improve their

ranking.

6. Monitor of waiting lists in health care

In the Netherlands, people are fee to choose hospitals that have been agreed upon by

healthcare insurance companies. In practice, most patients go to the hospital they have been

sent to by their general physicians. General physicians generally send patients to the nearest

hospital or to a specialized hospital when this is appropriate. This system generally seemed to

work well until – in the nineties – waiting list became an increasingly important problem (as

also happened in other countries (Foote, Houston, North, 2002).

For some years, in the Netherlands there has been a debate about waiting lists in

hospital health care. The minister of Health has tried to shorten these waiting list but –

because of the complex division of roles and responsibilities – this has not been easy. The

waiting list was basically treated as a drational queueT (Foote et al., 2002, p. 358): the minister focused on stimulating managing productive capacity through efficiency gains,

improved prioritization and better demand management in order to balance supply with

demand (see the same reference for alternative approaches to waiting list and criticism of

the rational queue approach). One of the things that made it difficult for the minister to

develop a policy to shorten waiting lists was that there was no information available.

Citizens complained that they had to wait long but it was not possible to analyze this

problem.

In the mid-nineties, the minister asked the National Association of Hospitals (in Dutch:

Nederlandse Vereniging van Ziekenhuizen) to set up a database with information on waiting

lists. Hospitals were not eager to cooperate but when the minister threatened to cut their

finances the hospitals had little choice and supplied information to the database. In May 2000,

the National Association of Hospitals made the information public through its Web site

(http://www.nvz-ziekenhuizen.nl). In the beginning, however, this Web site received little

public attention.

Again, just like in the case of the Quality Cards in education, a newspaper played an

important role. Journalists of the newspaper Algemeen Dagblad approached the National

Association of Hospitals to ask whether they could get the database with information on

waiting lists. The newspaper also put the information on a Web site. This Web site, however,

did receive a lot of attention because the newspaper published articles on waiting lists with

references to the Web site.

Two dthird partiesT – the newspaper Algemeen Dagblad and the National Association of Hospitals – provide information to stakeholders. The waiting lists monitors of both

the National Association of Hospitals and of the newspaper attract many hits. The

newspaper could not provide exact information on the number of hits but receives thirty

to forty e-mail reactions every week. The National Association of Hospitals gets 30,000

hits a month. Neither the National Association of Hospitals nor the Algemeen Dagblad

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185178

have information on the identity of the visitors to the Web site and the use of this

information.

Do patients use the information to look for a hospital with a shorter waiting list? The

research yielded contradictory answers to this question. Respondents mentioned various

examples of hospitals that received many more patients when the Waiting List Monitors had

indicated that waiting lists were considerably shorter than in other hospitals. However, most

respondents indicated that in view of the total number of patients the effect is limited. This is

generally attributed to a diverse list of limitations to choosing a hospital (Table 4). This

finding is in lime with findings in the Unites States that indicate that effects of transparency

on the choice for hospitals are limited (Van Everdinger, 2003).

An alternative use of the Waiting List Monitors is that patients can use this information to

express that their not satisfied with the hospital’s performance. Interviews with hospitals

indicate that they receive little feedback concerning the Waiting List Monitors. Patient dvoiceT is even more limited than dexitT.

When the newspaper had just started with the Waiting List Monitor it received a fair

amount of comments from patients who had to wait longer than was indicated on the

Waiting List Monitor. The newspaper then contacted the hospital to enquire why the

information was not adequate. If the newspaper kept on receiving comments about the

inadequacy of the information of certain hospitals, these hospitals were put on a dblack listT. This measure has had an effect. The number of comments the newspaper received from patients decreased strongly in a couple of months. The Web site has improved the

quality of the information on waiting lists because the information provided by hospitals

is checked by patients. This effect had already been suggested by (van Thiel & Leeuw,

2002: 278): making information accessible through the Internet increases the risk for

cheating agents to be caught.

Other stakeholders make extensive use of the Waiting List Monitors. Important are the

health insurance companies because they provide finances to hospitals. Health insurance

companies use information on waiting list for signing dproduction agreementsT with hospitals: What level of care will they deliver to the patients that are insured with this company? These

insurance companies also use the information in their help to patients: They help patients

finding a hospital that can provide the required care to them fast.

Table 4

Why patients do not use information on waiting lists to choose a hospital

Patients choose a hospital in their neighborhood

Patients go to a specialist they know

Patients follow the advice of general physician in choosing a hospital

Many patients are not have the state of mind to make a choice between hospitals

An overload of information makes choosing a hospital difficult

Patients are loyal to their hospitals

Hospitals do not facilitate switching: medical files are often not sent to other hospitals

Some hospitals put patients from their areas first on waiting lists

Quality is more important to patients than waiting time

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185 179

Media are as important to hospitals as they are to schools. Media follow developments in

waiting lists closely because this issue is heavily debated in the Netherlands. Interestingly

enough, hospitals do not fear that the amount of patients they attract will go down because

they all have too many patients. They do fear, however, that their reputation will be damaged

by negative publicity.

Accountability to stakeholders stimulates hospitals to perform better or – put more

cynically – score better on the Waiting List Monitors. Some hospitals react by redesigning

business processes and by creating more capacity. Hospitals, however, also exhibit strategic

behavior. Well-known forms of strategic behavior in health care are creaming – selecting

patients that can be helped easily and dumping – refusing patients that need complicated care.

Public relations management is also of growing importance: Negative publicity is not only

countered by taking measures to improve performance but also by communicative actions to

show that the hospital is not doing bad at all.

7. Comparison of the sectors

In many respects, the findings of the empirical research in the two sectors are similar. In

both sectors, crises created more transparency in the sector. In education, the crisis was

created by a journalist – a dpolicy entrepreneurT (Kingdon, 1984) – who forced the School Inspection Service to make its reports public. This led to more transparency but also to

drastic changes in the functioning of this service. The School Inspection Service has acquired

the task of providing independent information about school performance to students and their

parents. In health care, the crisis was of a political nature: There was a strong push from

members of parliament and media to shorten waiting lists in health care. This issue

dominated debates and demanded a solution. Transparency was one of the answers to this

crisis. In rhetoric public sector, organizations often stress that they want to be open in the

public, in practice these organizations only opened up when they were forced to. The

transparency only applies to publishing information. The Internet is hardly used for

communication: In both sectors, there were no opportunities for digital debates and exchanges

of opinion.

In both sectors, a variety of dthird partiesT provided information about performance results through the Internet to stakeholders: In education, a government inspectorate and a

newspaper, in healthcare an association of public service organizations and also a newspaper.

These newspapers basically provided the same information as the government inspectorate

and the association of public service organizations because they get the information from

them and have no access to independent information.

The opportunities that are created for accountability – the increased transparency – seem to

focus on the role of citizens as consumers. The Internet is mainly used to facilitate dchoiceT and creates few opportunities for dvoiceT. Quality Cards support citizens in choosing a school but the Internet is not used to stimulate debate between School Inspection Services, schools,

and citizens on the quality of schools. The Waiting List Monitors enable citizens to choose a

hospital with a short waiting list but does not provide for facilities to discuss health care.

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185180

Citizens are regarded as consumers that can make a choice and not as dcitoyensT that are involved in public affairs. This focus does not seem to lead to a strong democracy in which

citizens are actively involved in debates about the public sector. Debates about various

stakeholder’s criteria for acceptable performance do not take place on the Internet.

Additionally, the dconsumersT exhibit little interest in the information on school and hospital performance. In both sectors, the information on the Internet was accessed by

citizens but hardly used. Citizens made little use of the information in their choice for schools

and hospitals and even less use of the information to ask questions about school performance.

The information on Web sites enables accountability to citizens but the opportunities are not

used much. One could argue that citizens will need to go through a learning process and that,

in the near future, they will start using the information more. However, experiences in

countries with a longer tradition – mainly Anglo-Saxon countries – seems to counteract this

argument. In these countries, the information is still not used much for dexitT of dvoiceT (Hilhorst, 2001, p. 84).

However, citizens are not the only stakeholders. In both sectors, various stakeholders were

identified that use the information on the Internet to assess the performance of public

organizations. In education, employees were important and in health care insurance

companies are important. These stakeholder posses crucial resources (personnel and

finances). Withholding these resources can severely affect public sector organizations. This

observation highlights the importance of avoiding an exclusive focus on citizens. The effects

of an increased transparency of government performance can only properly be understood by

taking into account all relevant stakeholders.

Among the stakeholders, media play central role because public service organizations –

and also companies – fear negative publicity. The prime driver for change in education and

health care is reputation management. Organizations anticipate media attention and try to

avoid negative publications. Hospitals use public relations as a manner to counter negative

publicity. Generally, media seem to be the stakeholder that is regarded to be most important.

Internet does not seem to undermine the mediacracy: it strengthens it. Especially, local news

media are important to public organizations in the two sectors. The prime driver for change in

education and health care is not pressure by citizens but rather reputation management.

Organizations anticipate media attention and try to avoid negative publications. Hospitals use

public relations as a manner to counter negative publicity, schools are generally smaller and

often seem to lack the knowledge and the resources for good public relations management.

The effects of media pressure depends on the information that is published on the Internet.

The Quality Cards and the Waiting List Monitor both provide dpoor informationT concerning the performance of public service organizations. This poor information could form the input

for debates among stakeholders and with public service organizations on acceptable

performance but these debates do not take place. Schools and hospitals assume that

stakeholders want them to just score high on performance indicators and cannot check this

assumption because of the lack of debate with stakeholders.

In both sectors, the dpoor informationT results in forms of strategic behavior aimed at getting a better ranking. As Meyer and Gupta (1994) indicate, the fewer the number of

performance indicators, the more difficult it becomes to obtain an accurate report of an

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185 181

organization’s performance. Opponents of transparency argue that this information is

harmful: Public service organizations strive to score better on a limited amount of indicators

and it is questionable whether this results in quality improvement. Public information on

schools and hospitals might result in a performance paradox: higher scores on indicators but

less quality. Proponents will argue that poor information is just a first step in a process of

increasing transparency. Recent developments in the Netherlands indeed indicate that the

transparency in both sectors is still increasing: Richer information about the performance of

schools and hospitals is now provided to the public. The future will tell whether these efforts

will facilitate quality improvement in education and health care.

8. Public eyes

Empirical material collected in two sector studies was presented, which can be used to

answer the research question: What are the effects of stakeholder accountability – through the

Internet – on public service organizations? The general effect is that transparency stimulates

organizations to score better on performance indicators. The organizations do not react to

signals given by stakeholders but act as if these signals were given. The fact that dthird partiesT publish information on the Internet put a pressure on public service organizations. Public

organizations feel the dpublic eyesT on them and, although these eyes do not talk to them, they do stimulate them to improve their behavior. The dreceptorsT of public service organizations do not react to signals from stakeholders but pick up transparency as a signal. This finding is

shown in a revised version of the conceptual model (Fig. 2), which is much simpler than the

original conceptual model. The most striking difference is that the central column – in the

original model this column was filled with stakeholder behavior – is empty: When dthird partiesT publish the information, this has a direct effect on public service organizations because they anticipate reactions from stakeholders.

The effects of these reactions to transparency through the Internet and the drive for better

scores on performance indicators are not yet clear but seem to be in line with general

Fig. 2. Revised conceptual model.

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185182

observations about the effects of performance measurements in the public sector (de Bruijn,

2002; van Thiel & Leeuw, 2002). In education and health care, organizations are stimulated to

improve their performance. Schools are stimulated to improve their education and stimulate

cognitive development of students, hospitals are stimulated to shorten waiting lists. In both

sectors public service organizations also show strategic behavior. This strategic behavior

might lead to higher scores but not improve the effectiveness of these organizations. The risk

of a performance paradox is great. One may even fear a McDonaldization (Ritzer, 1993) of

the public sector: an exclusive focus on those aspects that can be measured. The diversity in

schools may diminish when choosing a different approach to education – for example, by

focusing more on creative and social development – is not stimulated because these results

are not measured.

The legitimacy of government is not affected strongly by stakeholder accountability. Not

many citizens use the information on the Internet and direct contacts with public service

organizations seem to be more important for their trust in these organizations. The findings

provide more support for negative than for positive effects on the legitimacy of public

organizations. The media are mainly interested in highlighting the failures of government and

the strong position of the media may lead to a decline in legitimacy. Citizens read mainly

negative publications about public service organizations and thus their trust in these

organizations may be damaged. On the other hand, information on the Internet is less biased

than information in the mass media. In both policy sectors, both good and bad scores are

published. Internet leads to disintermediation – citizens do not depend on journalists to

provide them with information – and thus they can forms their own opinion about public

service organizations.

In summary, opportunities for stakeholder accountability focus on access to information

and enable dpublic eyesT to monitor public sector performance. Internet is not used for debates between stakeholders and public organizations. This lack of communication

increases the risk of the dperformance paradoxT: public organizations only try to score on performance indicators without debating what these scores means about the actual quality of

their service.

Acknowledgments

The author would like to thank Paul ’t Hart and Mirko Noordegraaf for their comments on

a previous version of this paper.

Albert Jacob Meijer (1967) studied chemistry at the University of Nijmegen and

communication science at Wageningen University in the Netherlands. In November 2002,

Meijer received his PhD at Erasmus University Rotterdam for a thesis on parliamentary

and legal accountability in the information age. Since 2002, Meijer works at the Utrecht

School of Governance as an assistant professor. He teaches public administration and

policy sciences at the bachelor and master level. He does research on public account-

ability, on informatization in public administration, and on the use e-mail by government

organizations.

A.J. Meijer / Government Information Quarterly 24 (2007) 165–185 183

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