Search results

Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians’ own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians’ perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

This paper explores how conflicting institutional logics shape the behaviors of macro- and micro-level actors in their use of a calculative practice. Thereby, this paper explains how quantification can undermine the intended purpose of a governance system based on a single number.

The study draws upon the literature on calculative practices and institutional logics to present the case of how a single number—specifically the conversion factor for Atlantic Cod, established by macro-level actors for the purposes of governance within the Norwegian fishing industry—is interpreted and used by micro-level actors in the industry. The study is based on documents, field observations and interviews with fishers, landing facilities, and control authorities.

The use of the conversion factor, while intended to protect fish stock and govern industry actions, does not always align with the institutional logics of micro-level actors. Especially during the winter season, these actors may seek to serve their interests, leading to potential system gaming. The reliance on a single number that overlooks seasonal nuances can motivate unintended behaviors, undermining the governance system’s intentions.

Integrating the literature on calculative practices with an institutional logics perspective, this study offers novel insights into the challenges of using quantification for the governance of complex industries. In particular, the paper reveals that when the logics of macro- and micro-level actors conflict in a single-number governance system, unintended outcomes arise due to a domination of the macro-level logics.

In developing countries, how risk management technologies influence management accounting and control (MAC) practices is under-researched. By drawing on insights from institutional studies, this study aims to examine the multiple institutional pressures surrounding an entity and influencing its risk-based management control (RBC) system – that is, how RBC appears in an emerging market attributed to institutional multiplicity.

The authors used qualitative case study research methods to collect empirical evidence from a privately owned Egyptian insurance company.

The authors observed that in the transformation to risk-based controls, especially in socio-political settings such as Egypt, changes in MAC systems were consistent with the shifts in the institutional context. Along with changes in the institutional environment, the case company sought to configure its MAC system to be more risk-based to achieve its strategic goals effectively and maintain its sustainability.

This research provides a fuller view of risk-based management controls based on the social, professional and political perspectives central to the examined institutional environment. Moreover, unlike early studies that reported resistance to RBC, this case reveals the institutional dynamics contributing to the successful implementation of RBC in an emerging market.

The climate crisis presents a global threat. Research shows the necessity of joint communication efforts across different arenas—media, politics, business, academia and protest—to address this threat. However, communication about social change in response to the climate crisis comes with challenges. These challenges manifest, among others, in public accusations of inconsistency in terms of hypocrisy and incapability against self-declared change agents in different arenas. This increasingly turns public climate communication into a “blame game”.

Strategic communication scholarship has started to engage in this debate, thereby acknowledging climate communication as an arena-spanning, necessarily contested issue. Still, a systematic overview of specific inconsistency accusations in different public arenas is lacking. This conceptual article provides an overview based on a macro-focused public arena approach and decoupling scholarship.

Drawing on a systematic literature review of climate-related strategic communication scholarship and key debates from climate communication research in neighboring domains, the authors develop a framework mapping how inconsistency accusations of hypocrisy and incapacity, that is, policy–practice and means–ends decoupling, manifest in different climate communication arenas.

This framework creates awareness for the shared challenge of decoupling accusations across different climate communication arenas, underscoring the necessity of an arena-spanning strategic communication agenda. This agenda requires a communicative shift from downplaying to embracing decoupling accusations, from mutual blaming to approval of accountable ways of working through accusations and from confrontation to cooperation of agents across arenas.

In this paper, the authors empirically and theoretically analyze the scaling and control of talent development to highlight an important part of commercialization in football clubs, especially in the light of a growing transfer market.

Conducting a single case study of a Swedish football club, the authors adapt a view of the club as a “high-intensity” organization (Alvesson and Kärreman, 2004), one that inherently relies on strong identification of employees and the fostering of talent. This view allows us to detail the importance of both socio-ideological and technocratic forms of control involved in the talent development process.

The authors show how socio-ideological and technocratic forms of control were combined to establish the football club as a “talent factory” in the league, as well as the corresponding challenges when scaling talent development activities and how these challenges were handled. In doing so, the authors contribute to the broader accounting literature on talent- and human resource management, as the authors provide an example of how football clubs may commercialize without necessarily violating their fundamental sports values.

Talent management has mainly been studied in terms of increasing player wages and a focus on the cost of talent. As opposed to these perspectives, the authors highlight the revenue potential in developing players in the light of a growing transfer market and the relevance of talent development for the commercialization of football clubs.

This rich descriptive study examines auditors' client risk assessment (i.e. “key audit matters”/critical audit matters) disclosures in expanded audit reports of 328 Financial Times Stock Exchange (FTSE) 350 companies. The study compares auditor-identified client risks with corporate risk disclosures identified in audit committee reports, in terms of number and type of risks. The research also compares variation in auditor-identified client risks between individual Big 4 audit firms. In addition, the study examines auditor ranking of their client risks disclosed.

The study manually content analyses disclosures in audit reports and audit committee reports of a sample of 328 FTSE-350 companies with 2015 year-ends.

Audit committees identify more risks than auditors (23% more risks). However, auditor-identified client risks and audit-committee-identified risks are similar (80% similar), as are auditor-identified client risks between the individual Big 4 audit firms. Only ten (3%) audit reports rank the importance of auditor-identified client risks.

Sample is restricted to one year, one jurisdiction, large-listed companies and companies audited by Big 4 auditors.

The study provides important insights for regulators, auditors and users of financial statements by identifying influences on disclosure of auditor-identified client risks.

The paper mobilises institutional theory to interpret the findings. The findings suggest that auditor-identified client risks in expanded audit reports may demonstrate mimetic behaviour in terms of similarity with audit-committee-identified risks and similarity between individual Big 4 audit firms. The study provides important insights for regulators, auditors and users of financial statements by identifying influences on disclosure of auditor-identified client risks.

This study aims to investigate why and how shared service centres (SSCs) are implemented as well as how they affect audit firm practice and audit quality.

In this qualitative study guided by the theoretical framework of institutional theory, the authors conducted 25 semi-structured interviews in seven European countries, including 16 interviews with audit partners from Big 4 firms, 6 with audit team members, 2 with interviewees from second-tier audit firms and 1 with a member of an oversight body.

The authors show that the central rationale for audit firms to implement SSCs is economic rather than external legitimacy. The authors find that SSC implementation has substantial effects on audit practices, particularly those related to standardisation, coordination and monitoring activities. The authors also highlight the potential impacts on audit quality.

By exploring the motivation for and effects of SSC implementation amongst audit firms, the authors offer insights into the best practices related to subsequent change processes and audit quality.

The paper aims to analyse the meaning and extension of discretionary power of social service professionals within network-based interventions.

Empirically, the paper is based on a case study of a network-based policy involving private and public organisations in the Northeast of Italy (Province of Trento).

The paper identifies netocracy as a social policy logic distinct from bureaucracy and professionalism. What legitimises netocracy is neither authority nor expertise but cooperation, the activation of connections and involvement, considered “good” per se. In this framework, professionalism and discretion acquire new and problematic meanings compared to street-level bureaucracy processes.

Based on a case study, the research results cannot be generalised but pave the way to further comparative investigations.

The paper reveals that the position of professionals in netocracy is to some extent trickier than that in a bureaucracy because netocracy seems to have the power to encapsulate them and make it less likely for them to deviate from expected courses of action.

Combining different literature streams – street level bureaucracy, professionalism, network organisations and welfare governance – and building on an original case study, the paper contribute to understanding professionalism in welfare contexts increasingly characterised by the combination of bureaucratic, professional and network logics.

This research addresses the professional logics of street-level managers (SLMs) and bureaucrats (SLBs) working in the Brazilian National Social Security Agency (INSS) through their perceptions of distributive justice and discretion. Since SLMs have the authority to influence SLBs' actions, we investigate whether these two groups hold similar viewpoints.

We integrate the administrative data and survey responses (n = 678) with earlier thematic content analysis (n = 350) in three stages: mean-testing, regression analyses and complementary qualitative analysis, integrated through a mixed-methods matrix.

Whilst no significant differences emerge in distributive justice ideas between groups, SLMs demand wider benefit-granting discretion, praising professionalism whilst adopting managerial posture and jargon.

The study adds to the theoretical discussions concerning SLM’s influence on SLB’s decision-making, suggesting that other factors outweigh it. The finding concerning the managers’ demand for wider discretion asks for further in-depth approaches.

Findings supply valuable insights for policymakers and managers steering administrative reforms, by questioning whether some roles SLMs play are limited to symbolic levels. Further, SLBs’ heterogenous formations might be more relevant to policy divergence than managerial influence and perhaps an underutilised source of innovation.

By approaching street-level management professional logics within a Global South welfare state through a mixed-methods approach, this study offers a holistic understanding of complex dynamics, providing novel insights for public sector management.