Doctors under the microscope: The birth of medical audit

William J. Jackson, Audrey S. Paterson, Christopher K. M. Pong (Corresponding Author), Simona Scarparo

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8 Citations (Scopus)


In 1989 a UK government White Paper introduced medical audit as a comprehensive and statutory system of assessment and improvement in quality of care in hospitals. A considerable body of research has described the evolution of medical audit in terms of a struggle between doctors and National Health Service managers over control of quality assurance. In this paper we examine the emergence of medical audit from 1910 to the early 1950s, with a particular focus on the pioneering work of the American surgeons Codman, MacEachern and Ponton. It is contended that medical professionals initially created medical audit in order to articulate a suitable methodology for assessing individual and organisational performance. Rather than a means of protecting the medical profession from public scrutiny, medical auditing was conceived and operationalised as a managerial tool for fostering the active engagement of senior hospital managers and discharging public accountability. These early debates reveal how accounting was implicated in the development of a system for monitoring and improving the work of medical professionals, advancing the quality of hospital care, and was advocated in ways, which included rather than excluded managers.

Original languageEnglish
Pages (from-to)23-47
Number of pages25
JournalAccounting History Review
Issue number1
Early online date14 Mar 2013
Publication statusPublished - Mar 2013


  • end results
  • medical audit
  • professional accounting
  • quality of care


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