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This paper aims to explore how accounting is fostering neoliberal citizenship through the participants of Australia’s National Disability Insurance Scheme (NDIS). More specifically, this paper aims to understand how accounting discourse and the management accounting technique of budgeting, when intertwined with automated administrative processes of the NDIS, are giving rise to a pastoral form of power that directs people’s behaviour toward certain ends.

Publicly available data has been crafted into an autoethnographic case study of one fictitious person’s experiences with the NDIS – Mina. Mina is an amalgam created from material submitted to the Joint Parliamentary Standing Committee on the NDIS. Mina’s experiences are then analysed through the lens of Foucault’s concept of pastoral power to explore how accounting has contributed to marketising and digitising public disability services.

Accounting rhetoric appears to be a central part of rationalising the decision to shift to individualised disability funding. Those receiving payments are treated as self-governable, financially responsible subjects and are therefore expected to have knowledge of management accounting techniques and budgeting. However, NDIS’s strong reliance on the accounting concepts of funds, budgets, cost and price is limiting people’s autonomy and subjecting them to intervention and control.

This paper addresses calls to explore the interplay between accounting and current disability policies. The analysis shows that incorporating accounting into the NDIS’s algorithms serves to conceal the underlying ideology of the programs, subtly driving behaviours towards neoliberal objectives. Further, this research extends the Foucauldian accounting literature by revealing the contribution of accounting to reinforcing the authority of digital pastors in contemporary times.

Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide insights into patients' perceptions of satisfaction, experience and self-reported outcomes. However, little attention has been devoted to questions about factors fostering the use of patient-reported information to create value at the system level.

Action research design is carried out to elicit possible triggers using the case of patient-reported experience and outcome data for breast cancer women along their clinical pathway in the clinical breast network of Tuscany (Italy).

The case shows that communication and engagement of multi-stakeholder representation are needed for making information actionable in a multi-level, multispecialty care pathway organized in a clinical network; moreover, political and managerial support from higher level governance is a stimulus for legitimizing the use for quality improvement. At the organizational level, an external facilitator disclosing and discussing real-world uses of collected data is a trigger to link measures to action. Also, clinical champion(s) and clear goals are key success factors. Nonetheless, resource munificent and dedicated information support tools together with education and learning routines are enabling factors.

Current literature focuses on key factors that impact performance information use often considering unidimensional performance and internal sources of information. The use of patient/user-reported information is not yet well-studied especially in supporting quality improvement in multi-stakeholder governance. The work appears relevant for the implications it carries, especially for policymakers and public sector managers when confronting the gap in patient-reported measures for quality improvement.