Chapter 3 examines a critical but overlooked example of medical efficiency: the American College of Surgeons Hospital Standardization Program. Contextualizing the origins of this program in the College’s earlier focus on surgical standardization, the chapter examines how this organization successfully navigated the thorny conceptual tensions intrinsic to standardization, threading the necessary needle of autocratic order and democratic consensus in the process. This case study is set within a larger discussion about standardization, describing especially the various methods by which standards might be brought into existence and the various significances that each method in turn invoked. The chapter also considers the disenfranchising impact of standardization, noting that the apparently broad, conceptual concerns that found critical voice in efficiency—democracy, for example—were in fact narrowly bounded from the outset in their relevance to a white “silent majority.”
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