Costs, Performance, and Accountability in an IVF Clinic: Digital innovations as a site of responsibilization

At the 2024 IPA conference I presented a single author working paper on the design, implementation, and social embedding of a co-created digital cost and performance dashboard at a fertility clinic. Modern healthcare strategies rely on increasingly granular cost and performance metrics, like patient-level costs or patient's satisfation scores. To steer daily behaviour, such organizations use dashboards or other digital innovations. Using a practice lense and ethnographic material, and by conceptualizing the innovative digital dashboard as a 'tertiary memory' (Stiegler, 1994) I show how doctors adjusted and shaped a co-constructed dashboard to suit their emotional and social needs, effectively embedding this technology in their daily practices. Under financial pressure, the dashboard was shaped by doctors to increasingly place cost and performance accountabilities onto the patient, and onto insurance companies. This rendered the dashboard as a site of moral reasoning and re-responsibilization.