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We utilise the actor-network theory (ANT) – based especially on Latour (2005) – to examine how management accounting tools affect physicians’ representations and new managerial practices in French public hospitals currently undergoing reform.

We conducted a longitudinal case study – based on interviews and observations – in a large French public hospital in which dashboards are diffused to physicians and nurses dealing with both medical and managerial activities.

The case shows that head physicians and nurses are implicated in their new managerial tasks and spend time analysing dashboards. Management accounting tools thus play a role, as mediators, in organising new managerial practices, and dashboards are a means of materialising and giving structure to new managerial practices and enabling discussions and exchanges to take place between actors who were previously separated.

The case shows that management accounting tools are not necessarily useful because they help in decision-making or control – as in the dominant paradigm; rather, they are beneficial because they may help in changing representations and building a new collective organisation. Future research should therefore expand on the organisational and social roles of management accounting tools, especially in the healthcare field.

Most ANT-inspired studies in management accounting focus on explaining changes in accounting practices, which are perceived as a consequence of an ANT process. This chapter, however, analyses the practices by which management accounting tools act as a vehicle to organisational change.

Despite hospitals’ efforts to reduce health care-associated infections (HAIs), success rates vary. We studied how leadership practices might impact these efforts.

We conducted eight case studies at hospitals pursuing central line-associated blood stream infection (CLABSI)-prevention initiatives. At each hospital, we interviewed senior leaders, clinical leaders, and line clinicians (n=194) using a semi-structured interview protocol. All interviews were transcribed and iteratively analyzed.

We found that the presence of local clinical champions was perceived across organizations and interviewees as a key factor contributing to HAI-prevention efforts, with champions playing important roles as coordinators, cheerleaders, and advocates for the initiatives. Top-level support was also critical, with elements such as visibility, commitment, and clear expectations valued across interviewees.

Results suggest that leadership plays an important role in the successful implementation of HAI-prevention interventions. Improving our understanding of nonclinical differences across health systems may contribute to efforts to eliminate HAIs.

Adopting an agentic positioning, we question and compare competing logics hybridization within French hospitals and universities facing major reforms inspired by new public management. In addition to the resulting forms of hybridization exposed in the literature (accepted or refused), we observe four additional modes: instrumentalized, uncomfortable, reformulated, and suffered. They all reveal the varied manner with which each professional faces reform. However, we develop a new argument: the ways professionals hybridize (or do not) their prevailing logic depends on an overarching mode of hybridization that characterizes the way their organization deals with reform. We identify two contrasting modes: overarching strategic logics hybridization and overarching enforced logics hybridization. They give insight into how actors decouple structure from practices. We contribute to the literature on logics hybridization by first analyzing the role of specific actors who act as either a translator-actor or a closure-actor to respectively facilitate appropriation of the reforms or to protect professionals against the growing dominance of the new logic introduced by the law; and secondly by discussing importance of articulating higher and lower organizational levels all involved in hybridization.

One common feature facing diverse health care organisations is a need to compare performance across geographical areas, institutions or individual practitioners. In all health care systems, comparative data help the central government formulate policies for distributing central grants, clinical education, public health, research and tackling disparities. Good comparative data also provides an important resource for decision-making by local managers and clinicians. Through the process usually known as benchmarking, institutions can explore which of their peers are performing best, and seek out detailed qualitative and quantitative information on the context and processes contributing to good performance. Benchmarking also helps local managers set targets and rewards, and permits local electorates pass judgment on their local governments. The central theme of this chapter is to describe how the national hospital benchmarking system (BMS) was implemented in Finland, focusing on the use of BMS for managerial purposes and its impact on hospital care.

This research explores perceptions of knowledge management processes held by managers and employees in a service industry. To date, empirical research on knowledge management in the service industry is sparse. This research seeks to examine absorptive capacity and its four capabilities of acquisition, assimilation, transformation and exploitation and their impact on effective knowledge management. All of these capabilities are strategies that enable external knowledge to be recognized, imported and integrated into, and further developed within the organization effectively. The research tests the relationships between absorptive capacity and effective knowledge management through analysis of quantitative data (n = 549) drawn from managers and employees in 35 residential aged care organizations in Western Australia. Responses were analysed using Partial Least Square-based Structural Equation Modelling. Additional analysis was conducted to assess if the job role (of manager or employee) and three industry context variables of profit motive, size of business and length of time the organization has been in business, impacted on the hypothesized relationships.

Structural model analysis examines the relationships between variables as hypothesized in the research framework. Analysis found that absorptive capacity and the four capabilities correlated significantly with effective knowledge management, with absorptive capacity explaining 56% of the total variability for effective knowledge management. Findings from this research also show that absorptive capacity and the four capabilities provide a useful framework for examining knowledge management in the service industry. Additionally, there were no significant differences in the perceptions held between managers and employees, nor between respondents in for-profit and not-for-profit organizations. Furthermore, the size of the organization and length of time the organization has been in business did not impact on absorptive capacity, the four capabilities and effective knowledge management.

The research considers implications for business in light of these findings. The role of managers in providing leadership across the knowledge management process was confirmed, as well as the importance of guiding routines and knowledge sharing throughout the organization. Further, the results indicate that within the participating organizations there are discernible differences in the way that some organizations manage their knowledge, compared to others. To achieve effective knowledge management, managers need to provide a supportive workplace culture, facilitate strong employee relationships, encourage employees to seek out new knowledge, continually engage in two-way communication with employees and provide up-to-date policies and procedures that guide employees in doing their work. The implementation of knowledge management strategies has also been shown in this research to enhance the delivery and quality of residential aged care.

This article looks at the alignment of performance management system with the strategy, structure, and organizational outcome in Canadian health care organizations. In this study, balanced scorecard is the framework adopted for assessing the health care organization's performance management system (PMS) and outcome. CEO and clinical unit managers were surveyed for their perceptions on their organization's strategy, autonomy structure, PMS, and organizational performance. Path analysis was the methodology used in examining the relationship about the above organizational variables. The results indicate that patient satisfaction is the primary and most significant perspective of the depicted balanced scorecard in organizational performance. Patient satisfaction and research criteria, on the other hand, are the significant perspectives of a balanced scorecard in an organization's PMS, which are linked to strategy, autonomy structure, and organizational performance. Moreover, the results show that the strategy/structure links operated as suggested. Surprisingly, strategy on service innovation has a negative impact on the organizational outcome of patient satisfaction. Uncertainty from continuous development and organizational change in pursuing service innovation and cost-cutting measures in response to fiscal constraints are plausible explanations of the adverse impact reported.

This chapter demonstrates (1) divergence between spending based upon a budget ratcheting model and a benchmark spending model, (2) that this divergence affects organizational performance, and (3) that internal benchmarking enables unit-to-unit performance comparisons, despite claims of organizational or unit uniqueness. We contrast two spending models to examine whether the divergence, or cost estimation gap, affects operating performance across inpatient (n=4,536) and outpatient departments (n=8,438) in 23 U.S. Army hospitals. Using a fixed-effects panel data methodology for fiscal years 2004–2006, we find that unit managers’ spending in this setting is more closely approximated by budget ratcheting. Using multiple performance metrics measured via a DuPont-like decomposition, we find that, within a specified range, operating performance generally improves as resources become constrained. Outside that range, however, we find nonlinear performance effects that approximate a quadratic loss function. Our benchmark model enables clinical department comparisons while controlling for facility, clinical specialty, and case mix severity. The resulting departmental comparability facilitates identification and communication of best practices across the entire Army hospital system. These results should be of interest to corporate executives, government officials, and agency managers who have responsibility for establishing funding mechanisms that include performance-based components.