Narrative accountability and quality awareness: Learning about (re)presenting narrative care

• To sustain development of narrative care, accountability practices should be taken into account;
• Accounting for narrative care doesn’t presuppose a dichotomy between ‘soft’ and ‘hard’ care issues;
• Enhancing quality awareness leads to innovative practices of accountability at various levels;
• Accountability seen as a relational constructionist concept does justice to the narrative core of care.
• Narrative accountability and quality awareness benefit from combining care practice, scientific research and policy making.

Over the years, the dominant accountability structures for eldercare in the Netherlands have conceptualized “care” in mainly quantitative terms, based on measurable outcomes and performance indicators. This article describes a two-year program that was designed to find ways for a renewed story of accountability and quality with a more “story conscious” way of engaging with the realities of both life and care. From the autoethnographical stance of the program manager, the article first provides the historical background of the program, tracing its roots in narrative gerontology. Second, it outlines the design of the program, which was meant to combine the practice of care organizations with scientific research and policy making. Third, it sheds light on issues of quality and accountability when eldercare is approached as a social constructionist practice. It concludes with some thoughts on how the learning gained in setting up the program are relevant to future policies regarding quality and accountability in eldercare.