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The Control Gap: The Role of Budgets, Accounting Information and (Non‐) Decisions in Hospital Settings
Author(s) -
Nyland Kari,
Pettersen Inger Johanne
Publication year - 2004
Publication title -
financial accountability and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.661
H-Index - 44
eISSN - 1468-0408
pISSN - 0267-4424
DOI - 10.1111/j.1468-0408.2004.00187.x
Subject(s) - negotiation , business , control (management) , obligation , function (biology) , accounting information system , interdependence , accounting , management control system , public hospital , management accounting , norwegian , public relations , process (computing) , knowledge management , medicine , economics , political science , nursing , management , linguistics , philosophy , evolutionary biology , computer science , law , biology , operating system
This paper investigates the link between budgets, accounting information and the decision‐making processes at both strategic and operational levels in a large Norwegian hospital, as this hospital now is facing the New Public Management reforms which have been introduced in Norway. The study has examined the use of budget and accounting information in the management control process. The empirical data are based on interviews with key actors in the decisionmaking process at all management levels in the hospital. The study found that budgets were not perceived by clinicians as important decision tools at the clinical levels in the hospital. The professionals felt a strong moral obligation to patients. This loose coupling between budget information and clinical action identified an inconsistency in the norms and values between the clinical and the managerial world of the hospital. In this two‐worlds of responsibilities the function of the clinical managers at the department levels was found to be of vital importance as mediators between top level managers and the individual clinicians in the department and specialities. Informal ‘coffee‐room talks’ indicated that dialogues were important means of control, which could compensate for the lack of more formal and cybernetic control systems. Such frequent and informal communication may also serve a buffering function because it offers meeting points for negotiation and adjustments to initial budgets during the year. These coordination mechanisms take the mode of network based organising which can be favourable in managing organisational interdependencies.