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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 refine and expand technology adoption theory for a healthcare logistics setting by combining the technology–organization–environment framework with a business process management (BPM) perspective. The paper identifies and ranks factors impacting the decision to implement instances of technologies in healthcare logistics processes.

A multiple case study is carried out at five Danish hospitals to investigate the bed logistics process. A combined technology adoption and BPM lens is applied to gain an understanding of the reasoning behind technology adoption.

A set of 17 factors impacting the adoption of technologies within healthcare logistics was identified. The impact factors perceived as most important to the adoption of technologies in healthcare logistics processes relate to quality, employee work conditions and employee engagement.

This paper seeks to understand how managers can use knowledge about impact factors to improve processes through technology adoption. The findings of this study provide insights about the factors impacting the adoption of technologies in healthcare logistics processes. Differences in perceived importance of factors enable ranking of impact factors, and prioritization of changes to be implemented. The study is limited to five hospitals, but is expected to be representative of public hospitals in developed countries and applicable to similar processes.

The study contributes to the empirical research within the field of BPM and technology adoption in healthcare. Furthermore, the findings of this study enable managers to make an informed decision about technology adoption within a healthcare logistics setting.

Healthcare provision in Denmark reflects some of the key principles of the welfare state. By securing relatively easy and equal access for all Danish residents regardless of income via general tax financing, the Danish healthcare system has strong ethical merits. All residents are entitled to comprehensive healthcare services. The Danish healthcare system is also relatively efficient. Total healthcare expenditures – including public and private – amount to 10% of GDP, above the OECD 8.8% average but well below the costs in the other Nordic countries, Germany, Switzerland and the United Stated. Notwithstanding its merits, healthcare in Denmark shares key predicaments with other OECD countries, primarily how to improve health outcomes while containing care expenditures. All of the OECD countries aim to improve population life expectancy and health quality. Yet their ageing and increasingly obese populations are exacerbating the demands on their respective healthcare systems. This chapter examines changes in how Denmark has managed these challenges. The main argument is that the healthcare system performance on managing health outcomes and costs improved remarkably from the 1990s to the early 2020s, although outcome inequalities remain. Notable changes in the system were targeted innovations in treatment procedures and expansion of municipal rehabilitation and preventive efforts, along with strict budget controls.

This study is about the Tanzania Ports Authority (TPA), a central institution in the country that has seen efforts towards improved performance in terms of cargo handled and revenue generated from port operations. This study identifies the actions that were taken by public institutional leaders as a result of political leadership call for performance improvements and implications therefrom for sustainable performance. It attempts to engage with both change and public value theories to make sense of TPA efforts and implications as a result.

The study was conducted at TPA headquarters in Dar-es-Salaam and involved the management and other staff members. The study design was descriptive and exploratory. Data collection involved mostly the use of semi-structured questionnaires and review of documents.

The study reveals that the efforts to improve performance at the TPA indicate success in terms of cargo handled and revenue increases. Factors that support change and factors that impede change efforts were also identified making reference to Lewin's change theories and ADKAR (awareness, desire, knowledge, ability and reinforcement) model. The varied level of improved performance is attributed to the emphasis on change factors and the origin of change that do not give the human element the requisite concern. The quest for performance improvement in the public sector organization is also found wanting on the failure to place the requisite emphasis on public value creation both in processes set in motion and the desired outcomes. A more planned systematic change, championed or internalized within the organization by internal players, specifically TPA's management, is also proposed for a better and more consistent sustainable change in performance at TPA and possible in other public organizations.

The study is about an organization within a change context that is driven by the top leadership of the country. There have been studies on TPA but not as a change process and not yet after 2015 when the country witnessed a very strong leadership. According to Kets de Vries (2016), powerful leadership in Africa has had little to show and a legacy to be lauded. Therefore, there might be some relevance to contribute to the reasons why most African leadership fails, if that is the case.

Performance can be achieved through change efforts that are driven by the country's top leadership when the context is right and support factors are present. What can be elusive is sustainable performance creating public value and that endures despite changes in the country's leadership, particularly when internal leadership of a public organization is not the change champion and is basically toeing a line, and the change process is not holistic. A more systemic approach to efforts to create strong organizations as opposed to strong individuals in leadership may be key to sustainable change in similar institutions in Tanzania and Africa.

The study is based on change management models that have gained long-term interest of both scholars and practitioners. It explores a performance-seeking initiative in a developing country's context that is driven by top country's political leadership. It is thus unique because the institutional leadership had to be in stride with national level changes that was centered on efforts to improve service delivery and to counter corruption and complacency in public institutions. It has also attempted to link change theories and public value creation in the quest for improved public performance.