Change within institutional theory: towards a framework of coping with change

Abstract

PurposeIn accounting literature, there is a strand of thought that is founded on the old institutional economics. One of the problems is that institutional theory can demonstrate resistance to change, not the formation of change. The purpose of this paper is to contribute to theory formation, in particular to enrich the institutional framework for understanding change, by showing how medical specialists in hospitals, in particular urologists, shape change processes in organizations as reflected in behavioral routines. The results will also contribute to the empirical understanding of medical specialists' behavior. This could generate dynamic accounts of organizational change and help to find a way towards an enhanced framework.Design/methodology/approachIn Dutch hospitals a new management control tool is implemented, which is the diagnose treatment combinations (DTC) system. A DTC is a way to describe the required medical procedures for a specific illness in a hospital. Here, an investigation is carried out on how and if the behavior of medical specialists changes because of this introduction.FindingsAfter analyzing interviews with urologists, four common themes are distinguished and scripted behavior is described. The individual tracks in scripts can be distinguished, but there is more. This is the story that gives coherence to the various behaviors and shows how the arrangement of behavioral routines in an organizational context forms organizational change through time.Research limitations/implicationsThis research was based on the institutional perspective. Another view on management control would emphasize other aspects of behavior. In addition, this was only based on one specialism in three hospitals, so generalizability of the results will be low.Practical implicationsThe results contribute to empirical understanding of medical specialists' behavior.Originality/valueThe results will contribute to the empirical understanding of medical specialists' behavior and it will contribute to theory formation in management control literature, in particular by enriching the institutional framework for understanding change.

Clinicians and accounting: A systematic review and research directions

“…Since the implementation of managerial reforms, the majority of clinicians considered managerial activities as timeconsuming, bureaucratic procedures focused on costs and far from being clinically oriented and useful to clinicians' primary role of care delivery (Bourn & Ezzamel, 1986b;Kralewski, Dowd, & Kaissi, 2005;Lawrence, 1999). Due to the perceived low benefits in terms of clinical performance, clinicians frequently carried out their managerial duties with little attention, and did not integrate the use of AISs in their decision-making processes (Börner & Verstegen, 2013;Kurunmaki et al, 2003;Lapsley, 2007;Nyland & Pettersen, 2004). They also struggled against the introduction of control and the implementation of AISs in HCOs and reduced the impact of changes in the healthcare sector (Bourn & Ezzamel, 1986a, 1986bGuven Uslu & Conrad, 2008;Jacobs, 1995;Jones, 2002;Kurunmaki, 1999aKurunmaki, , 1999bKurunmaki et al, 2003;Notman et al, 1987).…”

“…The predominance of clinicians' professional experience in their decision-making processes enhanced by their professional culture exacerbated their negative approach toward AISs (Elina, Juhani, & Tiina, 2006;Kastberg & Siverbo, 2016;Notman et al, 1987). In this sense, clinicians did not understand the potentialities of AISs for strategic purposes (Carlström, 2012;Elina et al, 2006), although they were required to perform both clinical and managerial activities (Börner & Verstegen, 2013;Forbes et al, 2004;Fulop, 2012;Kippist & Fitzgerald, 2009;Kurunmaki et al, 2003;Kurunmaki, 2004), thus becoming doctor-managers (Coombs, 1987). The medical education system is one of the causes of the negative approach of clinicians to AISs (Forbes et al, 2004;Kippist & Fitzgerald, 2009).…”

“…Medical education hinders clinicians' comprehension of AISs potentialities Börner & Verstegen, 2013;Carlström, 2012;Elina et al, 2006;Forbes et al, 2004;Fulop, 2012;Kastberg & Siverbo, 2016;Kippist & Fitzgerald, 2009;Kurunmaki et al, 2003;Kurunmaki, 2004;Notman et al, 1987 Clinicians' culture enhances their autonomy Bourn & Ezzamel, 1986b;Forbes et al, 2004;Jacobs, 2005;Jones & Dewing, 1997;Torbica & Fattore, 2010 Managerial training increases clinicians' commitment to and use of AISs Carlström, 2012;Jacobs, 1995;Macinati & Rizzo, 2014;Notman et al, 1987 Collaboration between controllers and clinicians and power of the two groups…”

“…Whereas 1980s' literature aimed at increasing the investigation of the process of emergence of the role of doctormanagers following the reforms (Coombs, 1987), recent studies advocate a broader focus on the factors that influence the diffusion of managerial practices in clinicians' activity (Campanale & Cinquini, 2016;Kurunmaki et al, 2003). In particular, the literature calls for an investigation of the characteristics of both clinicians and HCOs that can increase clinicians' willingness to accept their managerial role (Börner & Verstegen, 2013;Forbes et al, 2004;Fulop, 2012;Kippist & Fitzgerald, 2009;Kurunmaki et al, 2003;Kurunmaki, 2004). In this sense, according to different authors, factors such as clinicians' education, age, background, and gender should be taken into account to determine tendencies to resistance to AISs and their influence on performance (Fiondella et al, 2016;Kralewski et al, 2005).…”

Why has not it worked? An empirical application of the extended Burns and Scapens' framework within the implementation of a controlling department

“…Based on OIE, Burns and Scapens (2000) have developed a framework to study the processes of change in management accounting, widely used for more than 15 years (Bogt, 2008;Bogt & Scapens, 2012;Börner & Verstegen, 2013;Busco & Scapens, 2011;Rautiainen & Scapens, 2013;Ribeiro & Scapens, 2006;Siti-Nabiha & Scapens, 2005;Van der Steen, 2009, 2011Youssef, 2013).…”