Search results

This paper aims to advance recent literature on the performativity of accounting by examining how project accounting affects a project organization’s ability to deliver a relevant project outcome, such as a product or a building, for a receiving client organization.

The paper draws on a longitudinal case study of a 41.4-billion-kroner (5.5-billion-euro) Danish project of constructing 16 new public hospitals. Its objective was to reduce the average unit costs and improve the quality of patient care. Each hospital construction was managed by a separate project organization and handed over to a separate receiving hospital organization. The project organizations applied a common approach to project accounting. The paper relies on Michel Callon’s concepts of performativity and sociotechnical agencement – approaching project accounting as an arrangement of devices.

The paper shows that the project-accounting agencement simultaneously supported and undermined the project organizations’ ability to deliver hospitals relevant to the receiving hospital organizations. The agencement performed hospital designs, disciplined project actors and guided decision-making, thus supporting the overall work of the project organizations. It also, however, compelled the project organizations to compromise on hospital designs when unexpected events occurred. These compromises led to the delivery of hospitals, which largely prevented the receiving hospital organizations from achieving the project’s objective.

This paper advances our limited understanding of the dynamic and complex relationship between project accounting and the relevance of project outcomes. It introduces the concept of a “contronymity device” to capture the way project accounting simultaneously produces two opposing consequences, both supporting and undermining the enactment of a particular reality. The paper lastly enriches our understanding of how project-accounting devices impact hospital organizations’ operating cost structures and challenge patient care capabilities.

The purpose of this paper is to report on an action research project carried out in an Italian university hospital that was facing a strategic challenge. The role of intellectual capital (IC) for university hospital strategic management is discussed after developing and applying an IC framework to enhance the visualisation of strategic IC elements.

An action research process has been applied in the studied setting based on Susman and Evered’s (1978) definition of the engaged research cycle.

The action research process allowed a gap between theory and practice to be bridged; the strategic control process resulted supported by new measures; a different approach to strategy management was launched, and other organisations perceived the relevance of the IC representation and wished to import it.

Research limitations are related to those recognised for the interventionist research approach.

The paper contributes to the improvement of managerial and accounting technologies for practitioners managing university hospitals and discusses a university hospital’s strategic goals.

The paper represents a methodological contribution related to the interventionist research stream of literature, and enriches the limited studies focused on IC in health care organisations. Furthermore, the paper enables appreciation of the role of academics in the convergence of theory and practice.

Analyses the way hospital organisation models handle the relationship between medical specialists and hospital management. All models that have been developed during the last ten years seek to integrate the medical specialists in the hospital organisation by formally subordinating them to the hospital management. However, recently a new model has come to the fore ‐ the “co‐makership” ‐ in which the hospital management and the medical specialists are assigned a position alongside each other.

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.

In this chapter, we describe a multilevel, longitudinal, comparative case study approach for investigating organizational heterogeneity based on our experience studying institutional change in the health care field (Scott, Ruef, Mendel, & Caronna, 2000). By examining the relationship between organizations, populations, and fields, differences between organizations can be captured in terms of their organizational identities as well as their (changing) relationships with the organizational field. We discuss the analytical strategies we used in our study of institutional change and describe our findings of organizational heterogeneity across levels and over time. We conclude with suggestions for future research that incorporate elements of our study design and lessons from our research process and outcomes.

The aim of this study was to analyse strategic planning practices in complex systems by investigating the experiences of Brazilian non-profit hospitals. Growing pressures have been imposed upon hospitals to improve the quality of their services, to increase access to them by reducing costs and to improve their reliability. In order to respond to these demands, managerial approaches such as strategic planning based on business-sector practices have been adopted by non-profit hospitals. The purpose of this study was to identify the most significant results of the experience with strategic planning in two non-profit hospitals. The study is a qualitative one, and the research was based on the concepts of organizational complexity, strategic planning and managerialism in non-profit hospitals. Data were collected by non-participant observation, from documents and in interviews and were analysed using narrative analysis and document-analysis techniques. Three main factors related to strategic planning in non-profit hospitals were identified: firstly, the unsuitability of strategic planning for hospitals given that they are complex, professional organizations, something that was disregarded by managers; secondly, the significant role played by core operating professionals in strategy making; and thirdly, the representation of strategic planning as fancy management in the eyes of internal and external stakeholders, conferring legitimacy on and generating trust in the hospital. The findings indicate that strategic planning as a traditional managerialist approach applied in a hospital context was dysfunctional and failed to produce a significant contribution to organizational performance.

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

This study looks at board governance in Ontario hospitals.

We conducted a research of the hospitals’ websites and a survey of board directors to study the board structure and examine governance practice in Ontario hospitals.

The findings suggest that the board structure and process in Ontario hospitals are in compliance with Accreditation Canada’s Governance Standards, and such administrative controls are appropriate. Ontario hospital boards, in general, have fulfilled their key functions of governance in terms of working as an effective board; developing a clear direction; supporting the organization to achieve its mandate; maintaining positive relationships with external stakeholders; and being accountable and achieving sustainable results. Building knowledge through information is an area where improvement is needed.

Ontario hospitals have implemented appropriate administrative controls in terms of board composition and committee structure. The results of a survey of 99 board directors from over 25 hospitals suggest that directors, in general, have a good understanding of their governance role and relationship with senior management as well as the government. The findings are also supportive of good governance practice where executives manage and nonexecutive directors monitor the performance of the executives. According to the respondents, Ontario’s hospital boards are actively involved in setting the mission, strategic goals and objectives of their organizations, and they take appropriate steps to ensure that risk management, client safety, and quality improvements are incorporated in their governance and strategic planning process. In order to discharge their fiduciary duty effectively, respondents would like to have more information from different sources. This is an area where management accounting professionals can become involved such that relevant information from a variety of sources, especially external sources, are provided to board directors for decision making.

Ontario’s hospital sector has undertaken initiatives through research and publications to promote good governance practice. Such leadership is critical to ensure that directors have the competence and skills to discharge their duties and responsibilities diligently. Hospital boards should focus on renewal while ensuring that board directors are equipped for the challenging task of governing through professional development and continuing education.

Limitations related to the use of questionnaire applies to this research study. Self-selection bias and low response rate limit the generalizability of the findings. Future research can examine the behavior of directors in the boardroom and the impact of governance variables on hospital performance, such as quality of care and patient safety.

Since the execution of National Health Insurance system in Taiwan, the competition of medical industry is becoming more and more severe. The ways the hospital operate knowledge management (KM) concept, combine current human resources and professional knowledge by information techniques and upgrade the competitiveness through reinvention of organizational culture have become the important issues. This research is based on the relationship between KM and organizational operation, integrates the characteristic of medical institutions and framework of medical knowledge cycle and starts the research subject by questionnaires from three dimensions: current situation of KM construction in medical organizations, executive effect of KM activities and the challenges faced by KM; subsequently, from qualitative interview, this research attempts to understand how a medical organization executes and adjusts in the consideration of theory and reality as well as quality and costs when actually operates the organization. This research accesses to KM system application of medical institutions and the empirical executive benefits and difficulties through questionnaires. The research results are as follows: (1) having initial understanding toward current KM establishment of medical institutions; (2) confirming the most important items of KM establishment of medical organizations; (3) understanding the most difficulty which the medical organizations encounter when executing KM; (4) establishing medical knowledge cycle figure of the hospitals receiving interviews. Through case interview, this research profoundly accessed to the actual operation of KM application of medical organizations. The target hospitals intended to try many medical KM measures; however, during to complicated hospital organizations and cultural characteristics, the promotion was not successful and the results were not apparent. The most difficulty was to change the employees’ behavior. The targets believed that only the continuous promotion of KM can allow it to be an important aspect of organizational culture and the competitiveness could constant be upgraded.

Hospital leaders are being challenged to become more consumer-oriented, more interprofessional in their approach to care and more focused on outcome measures and continuous quality improvement. The concept of the learning organization could provide the conceptual framework necessary for understanding and addressing these various challenges in a systematic way. The paper aims to discuss these issues.

A scan of the literature reveals that this concept has been applied to hospitals and other health care institutions, but it is not known to what extent this concept has been linked to hospitals and with what outcomes. To bridge this gap, the question of whether learning organizations are the answer to improving hospital care needs to be considered. Hospitals are knowledge-intensive organizations in that there is a need for constant updating of the best available evidence and the latest medical techniques. It is widely acknowledged that learning may become the only sustainable competitive advantage for organizations, including hospitals.

With the increased demand for accountability for quality care, fiscal responsibility and positive patient outcomes, exploring hospitals as learning organizations is timely and highly relevant to senior hospital administrators responsible for integrating best practices, interprofessional care and quality improvement as a primary means of achieving these outcomes.

To date, there is a dearth of research on hospitals as learning organizations as it relates to improving hospital care.