Samenvatting

Healthcare is often dominated by the curative domain. Yet, for a new way of improving of and accounting for quality of care, we have to shift our focus to the care for people with disabilities. Since long, quality of care is translated into performance indicators and standards. This reductive way of measuring quality was pursued for the entire healthcare sector. Where this might fit in with hospital care, it was experienced as constraining in care for the disabled. In this sector it was seen as a poor representation of the plurality of healthcare provision. A number of ‘quality rebels’ aimed to create a more suitable and rich Quality Framework for the sector, with attention for objective, subjective and intersubjective dimensions of care. In this article, we analyze the way in which the sector has realized this aim, and we show how this rebellious sector succeeded in transforming the idea of accountability for quality of care, by emphasizing on the reflection and learning processes that take place at all levels of the sector, and beyond. A new approach which requires a continuous cycle of disrupting, creating, and maintaining institutionalized patterns of thinking and doing. It requires ‘rebel learning’.