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Article
Publication date: 1 September 1994

Stewart Lawrence, Manzurul Alam and Tony Lowe

Examines the move towards a commercialized, economically driven, healthsector in New Zealand. Reforms involve extensive organizationalrearrangements and the creation of…

2961

Abstract

Examines the move towards a commercialized, economically driven, health sector in New Zealand. Reforms involve extensive organizational rearrangements and the creation of profit‐driven businesses in place of public hospitals. These institutional rearrangements involve the fabrication of new ways of accounting. Attempts to understand the processes involved in the development of information technologies before they become accepted “facts” of organizational life. The fabrication of new technologies cannot be understood as an autonomous sphere of activity, but has to be understood as part of a complex series of political, economic and organizational contexts. Accountants are viewed not as mere technicians reporting on what is, but as active agents contributing to change. Accounting often acts as an arbiter in social conflict. Nowhere is this more evident than in the way it is being called upon to assist in the implementation of clause 25 of the Health and Disability Services Bill, which requires hospitals in New Zealand to act as competitive profit motivated commercial enterprises while at the same time meeting unspecified social obligations. The creation of a pseudo‐market for health services presents a challenge not only for accountants, but for all New Zealand citizens. The outcomes of the radical reforms are uncertain and some fear that the massive restructuring is in the form of an experiment. It is based on an ideology lacking empirical support. In the end it may be shown to have been impractical in the New Zealand context.

Details

Accounting, Auditing & Accountability Journal, vol. 7 no. 3
Type: Research Article
ISSN: 0951-3574

Keywords

Article
Publication date: 26 August 2014

Hannele Kantola

The purpose of this paper is to describe the standardization of cost accounting by diagnosis-related groups (DRG) and how specialized medical care has managed this change in…

Abstract

Purpose

The purpose of this paper is to describe the standardization of cost accounting by diagnosis-related groups (DRG) and how specialized medical care has managed this change in Finland.

Design/methodology/approach

Qualitative research material was collected over six years to analyze the changes in the standardization process.

Findings

It was found that individual actors customize the process to meet their needs. Because the goal of standardization is comparison, the customization does not result in a homogenous national system.

Research limitations/implications

This paper’s limitation is that it focusses on an investigation of the adoption and use of the DRG system in hospital districts. Extending the research from this area to also cover health centres and regional hospitals could provide a broader picture of the use of the system.

Practical implications

Even though the actors report that they are using the DRG, our research illustrates how the same system is used in different ways and for different purposes in different organizations that impacts the original goal of national cost comparability.

Originality/value

This paper’s contribution is to show how the construction of an accounting system takes shape when spreading through organizations and society, and how its homogeneous nature is managed.

Details

Journal of Accounting & Organizational Change, vol. 10 no. 3
Type: Research Article
ISSN: 1832-5912

Keywords

Article
Publication date: 5 February 2018

Joseph Phiri and Pinar Guven-Uslu

The purpose of this paper is to investigate accounting and performance reporting practices embraced in the midst of a pluralistic institutional environment of an emerging economy…

Abstract

Purpose

The purpose of this paper is to investigate accounting and performance reporting practices embraced in the midst of a pluralistic institutional environment of an emerging economy (EE), Zambia. The research is necessitated due to the increased presence and influence of donor institutions whose information needs may not conform to the needs of local citizens in many EEs.

Design/methodology/approach

The study draws on institutional pluralism and Ekeh’s post-colonial theory of “two publics” to depict pluralistic environments that are typical of EEs. Primary data were collected through semi-structured interviews with 33 respondents drawn from the main stakeholder groups involved in health service delivery including legislators, policy makers, regulators, healthcare professionals and health service managers. Data analysis took the form of thematic analysis which involved identifying, analysing and constructing patterns and themes implicit within the data that were deemed to address the study’s research questions.

Findings

Findings indicate that Zambia’s institutional environment within the health sector is highly fragmented and pluralistic as reflected by the multiplicity of both internal and external stakeholders. These stakeholder groups equally require different reporting mechanisms to fulfil their information expectations.

Social implications

The multiple reporting practices evident within the health sector entail that the effectiveness of health programmes may be compromised due to the fragmentation in goals between government and international donor institutions. Rather than pooling resources and skills for maximum impact, these practices have the effect of dispersing performance efforts with the consequence of compromising their impact. Fragmented reporting equally complicates the work of policy makers in terms of monitoring the progress and impact of such programmes.

Originality/value

Beyond Goddard et al. (2016), the study depicts the usefulness of Ekeh’s theory in understanding how organisations and institutions operating in pluralistic institutional environments may be better managed. In view of contradictory expectations of accounting and performance reporting requirements between the civic and primordial publics, the study indicates that different practices, mechanisms and structures have to be embraced in order to maintain institutional harmony and relevance to different communities within the health sector.

Details

Journal of Accounting in Emerging Economies, vol. 8 no. 1
Type: Research Article
ISSN: 2042-1168

Keywords

Article
Publication date: 5 September 2016

Katarina Kaarbøe and Anne Robbestad

This paper aims to explore how accrual accounting is translated into new accounting norms and what role change agents have had in that process. The main research question is: How…

Abstract

Purpose

This paper aims to explore how accrual accounting is translated into new accounting norms and what role change agents have had in that process. The main research question is: How were private sector accounting norms translated within the Norwegian public health sector?

Design/methodology/approach

This study uses framing theory to understand how the different actors involved in the translation frame their arguments. The field study considers the specific case of public health care. The main data sources are archival data combined with semi-structured interviews.

Findings

The empirical study uses framing theory to show how the Big Four consultants worked as change agents to impose a valuation based on a full accrual accounting logic. The first finding shows that there are two framing processes to valuate fixed assets. The central government has a pragmatic framing trying to get the budget in balance, while the Big Four consultants together with private sector accounting experts have an accrual accounting ideology framing. The second finding shows how the Big Four consultants become a change agent by forming alliances with accounting experts, health enterprises and politicians. These findings point to the need to focus explicitly on the role of change agents as drivers of public sector organizational change and the important role accounting as a tool can have.

Practical implications

The paper is likely to be useful for governments, practitioners and researchers to gain knowledge about the implementation of accrual accounting.

Originality/value

This paper contributes to our understanding of change agent's role in successfully introducing a new accounting logic in the public sector, especially within an inter-organizational setting.

Details

Journal of Accounting & Organizational Change, vol. 12 no. 3
Type: Research Article
ISSN: 1832-5912

Keywords

Abstract

Details

Government and Public Policy in the Pacific Islands
Type: Book
ISBN: 978-1-78973-616-8

Article
Publication date: 10 June 2021

Joseph Phiri and Pinar Guven-Uslu

This paper aims to investigate funding and performance monitoring practices in Zambia’s health sector from an institutional and stratified ontology perspective. Such an approach…

Abstract

Purpose

This paper aims to investigate funding and performance monitoring practices in Zambia’s health sector from an institutional and stratified ontology perspective. Such an approach was deemed appropriate in view of pluralistic institutional environments characterising most African economies that are also considered to be highly stratified.

Design/methodology/approach

Blended with insights from stratified ontology, the paper draws on institutional pluralism as a theoretical lens to understand the institutional structures, mechanisms, events and experiences encountered by actors operating at different levels of Zambia’s health sector. The study adopted an interpretive approach that helped to investigate the multifaceted and subjective nature of social phenomena and practices being studied. Data were collected from both archival sources and interviews with key stakeholders operating within Zambia’s health sector.

Findings

The study’s findings indicate the high levels of stratification within Zambia’s health sector as evidenced by the three sector levels that possessed different characteristics in terms of actor responses to donor influence. This study equally demonstrates the capacity of agents operating under highly fragmented institutional environments to engage in enabling and constraining responses depending on the understanding of their empirical world.

Originality/value

Through blending insights from stratified ontology with institutional pluralism, the study contributes to the literature by demonstrating the enabling and constraining reflexive capacity of agents to exercise choices under highly fragmented institutional environments while responding to multiple demands and expectations to sustain the co-existence of diverse stakeholders. Accordingly, the study advances thinking on the application of institutional theory to critical accounting research in line with recent ontological and epistemological shifts in institutional theory.

Details

Journal of Accounting & Organizational Change, vol. 18 no. 2
Type: Research Article
ISSN: 1832-5912

Keywords

Article
Publication date: 1 August 2000

Alan Lowe

The purpose of this paper is to provide an explanation and understanding of developments in casemix and related information systems at a large regional hospital, Health Waikato…

Abstract

The purpose of this paper is to provide an explanation and understanding of developments in casemix and related information systems at a large regional hospital, Health Waikato (HW), in the centre of the North Island of New Zealand. The themes will be explicated and theorised, drawing on the sociology of translation (Latour). A central idea will be the use of accounting techniques to influence decision makers both within and outside the health institutions. The power of accounting in the translation and inscription of data (the fabrication of accounting systems per Preston et al.), will be a central theme in understanding the role of accounting systems as technology. Drawing from Latour has helped to provide a frame of reference to allow an assimilation of disparate changes and influences as they have come to affect the health sector at a national level, within New Zealand, and also at an organisational level, within a large regional health provider. This paper provides a detailed description of events at the research site, a large regional hospital (HW). The paper consists primarily of a descriptive case study of aspects of the change process as it has impacted on the research site.

Details

Journal of Management in Medicine, vol. 14 no. 3/4
Type: Research Article
ISSN: 0268-9235

Keywords

Article
Publication date: 1 March 2000

Alan Lowe

The purpose of this paper is to provide an explanation and understanding of developments in casemix and related information systems at a large regional hospital, Health Waikato…

1235

Abstract

The purpose of this paper is to provide an explanation and understanding of developments in casemix and related information systems at a large regional hospital, Health Waikato (HW), in the centre of the North Island of New Zealand. The themes will be explicated and theorised, drawing on the sociology of translation (Latour, 1987a). A central idea will be the use of accounting techniques to influence decision makers both within and outside the health institutions. The power of accounting in the translation and inscription of data (the fabrication of accounting systems per Preston et al., (1992)), will be a central theme in understanding the role of accounting systems as technology. Drawing from Latour has helped to provide a frame of reference to allow an assimilation of disparate changes and influences as they have come to affect the health sector at a national level, within New Zealand, and also at an organisational level, within a large regional health provider. This paper provides a detailed description of events at the research site, a large regional hospital (HW). The paper consists primarily of a descriptive case study of aspects of the change process as it has impacted on the research site.

Details

Accounting, Auditing & Accountability Journal, vol. 13 no. 1
Type: Research Article
ISSN: 0951-3574

Keywords

Article
Publication date: 11 September 2007

Irvine Lapsley

The purpose of this paper is to investigate the impact of accounting on clinical practices.

1023

Abstract

Purpose

The purpose of this paper is to investigate the impact of accounting on clinical practices.

Design/methodology/approach

This paper reviews existing studies of clinical budgeting; analyses publicly available data on cost‐effectiveness recommendations for the NHS; analyses publicly available data on the influence of accounting in medical dilemmas.

Findings

The paper finds that there is limited evidence of clinical budgeting dominating clinical decisions, but there is some evidence of central agency directions on appropriateness of treatments, but this is on a cost‐effectiveness basis. Numerous examples of adverse medical outcomes are cited in this paper – but with limited influence of accounting in these decisions.

Originality/value

The paper shows that the combination of accounting and medical data in a topical matter makes this an original and distinctive study.

Details

Journal of Health Organization and Management, vol. 21 no. 4/5
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 1 March 1994

David M. Rea

The Resource Management Initiative (RMI) is a central ingredient inplans to instil market‐based relationships in health care and medicine.However, these plans have not benefited…

1232

Abstract

The Resource Management Initiative (RMI) is a central ingredient in plans to instil market‐based relationships in health care and medicine. However, these plans have not benefited from any adequate assessment of “resource management”. Demonstrates how earlier experience with resource management provides little guidance as to how it might be made to work. While resource management implies that measures of cost and activity were to be related to each other, its purposes are confused and confusing. While seemingly offering a variety of advantages, resource management is characterized by struggles and negotiations over its operational substance. Moreover, the initiative failed to resolve crucial issues over how to account for activities. Experience of tackling these issues as market‐based relationships came into effect during 1992‐3 demonstrates that resource management provides limited assistance to managers of the service.

Details

Accounting, Auditing & Accountability Journal, vol. 7 no. 1
Type: Research Article
ISSN: 0951-3574

Keywords

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