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Hybridity and the use of performance measurement: facilitating compromises or creating moral struggles? Insights from healthcare organizations

Agathe Morinière (University of Montpellier, Montpellier, France)
Irène Georgescu (University of Montpellier, Montpellier, France)

Accounting, Auditing & Accountability Journal

ISSN: 0951-3574

Article publication date: 23 July 2021

Issue publication date: 9 March 2022

379

Abstract

Purpose

This study aims to understand whether and how the use of performance measures in the context of healthcare organizations facilitates the dynamics of compromise or whether it creates moral struggles among a wide variety of actors. It offers novel insights into the concept of hybridity by investigating its underlying moral dimension. Drawing upon the sociology of worth theory (Boltanski and Thévenot, 1991, 2006), this paper examines how actors negotiate and compromise over time concerning issues of justice, involving the use of performance measures on a day-to-day basis.

Design/methodology/approach

The article presents a single case study of a medical unit in a French public hospital. Data were obtained through the ethnographic method, semi-structured interviews and internal financial and accounting documents.

Findings

Unlike earlier accounting studies, the authors analyze whether, and how, accounting, on one hand, contributes to the dynamics of compromise between actors with divergent values that characterize hybrid organizations, and, on the other hand, increases tensions among actors with convergent values involved in caregiving. This offers practical insights into three relational mechanisms underlying the dynamics of compromise and their limits through the time dimension.

Research limitations/implications

The authors use a single case study in a country-specific context.

Practical implications

This study helps managers of healthcare organizations to understand the relationships between the use of performance measures and their impact on the evaluation of worth in practice.

Originality/value

In terms of theoretical contribution, the authors show how the sociology of worth (Boltanski and Thévenot, 1991, 2006) complements the analysis of hybridity and develop an original approach to understanding the ambivalent role of performance measures in bringing together divergent values within French public hospitals.

Keywords

Acknowledgements

The authors are grateful to Christine Cooper and Ann Langley for their encouraging comments on earlier versions of this study. The authors also thank the anonymous reviewers from the European Accounting Association congress of 2019 and from the Academy of Management congress of 2019. The authors acknowledge financial support from the Chaire Innov'Eres of the University of Montpellier. Finally, the authors want to thank the editor and the two anonymous reviewers.

Citation

Morinière, A. and Georgescu, I. (2022), "Hybridity and the use of performance measurement: facilitating compromises or creating moral struggles? Insights from healthcare organizations", Accounting, Auditing & Accountability Journal, Vol. 35 No. 3, pp. 801-829. https://doi.org/10.1108/AAAJ-12-2019-4309

Publisher

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Emerald Publishing Limited

Copyright © 2021, Emerald Publishing Limited

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