Incorporating Public Values Through Multiple Accountability: A Case Study on Quality Regulation of Emergency Care in the Netherlands by an Independent Regulatory Agency

In this paper, we explore how multiple accountability (MA) can enable an independent regulatory agency to deal with multiple conflicting public values in a complex and politically salient decision-making process. We examined the decision-making process of the Dutch National Health Care Institute on quality regulation of emergency care in the Netherlands. Using insights derived from ethnography, document analysis, and interviews, we show that MA resulted from strategic interactions between the Institute’s vertical and horizontal accountability forums. We argue that MA impeded efficiency but also enabled the Institute to deal with multiple conflicting public values.