Putting the patient first? The story of a decoupled hospital management quality initiative

From centralized DRG costing to decentralized TDABC-assessing the feasibility of hospital cost accounting for decision-making in Denmark

“…Triantafillou [57] has similar concerns in a Danish setting as is further highlighted by other studies. Although we do not investigate the strategic part of VBHC, we pursue the cost accounting, which despite the strategic focus, is essential in steering and prioritizing activities in health because cost accounting lays the foundation for essential decision-making [2,5].…”

“…Within the last 5 years, there has been an increasing wish and attempt to disregard productivity and DRG rates as steering elements and, instead, pursue the international trend of value-based management [47,55,56]. Different local attempts of implementing non-financial performance measures to support a patient focus have been initiated [57][58][59]. In a similar vein, there has been a change in the managerial accounting focus, where in 2017, a wish towards more reliable and valid accounting data has been stated and an analysis initiated to map such a need and its application [45].…”

Is Institutional Research on Management Accounting Degenerating or Progressing? A Lakatosian Analysis*

“…However, similar to Covaleski and Dirsmith (1988a), Dambrin et al (2007) cautioned that such states of decoupling may change over time since the constitutive power of accounting may ultimately contribute to the reshaping of subjective identities and align such identities with emerging ideals. This argument was borne out empirically by Malmmose and Kure (2021), who showed that certain accounting practices, which might be expected to be decoupled from operating-level decision-making and control, can create new social realities that may be difficult to change once they are institutionalized and start to transform people's professional identities. In their longitudinal field study in the Danish health care sector, they observed how the institutionalization of financial control practices reinforced an efficiency-centered rationale that hampered the subsequent implementation of patient-focused quality control practices.…”

“…Only two studies exploring the influence of institutional isomorphism have rekindled this interest in the constitutive role of accounting (Dambrin et al 2007; Malmmose and Kure 2021). Based on an in‐depth, process‐oriented analysis, Dambrin et al (2007) showed how accounting practices adopted in response to institutional pressures contributed to institutionalize novel, business‐oriented ideals in a pharmaceutical company and how the discourses associated with such ideals reinforced their objectification, although they remained decoupled from the subjective identities of individual employees.…”

Coherence in the use of a performance measurement system and compatibility between institutional logics in public hospitals

“…At the societal level, managerial research has identified some distinct institutional orders, such as the state, communities and labour unions, in which individuals and organisations regularly interact and agree on shared rules and beliefs (DiMaggio and Powell, 1991; Friedland and Alford, 1991; Thornton, 2004). At the field level, management accounting research has emphasised the persistent relevance of the health professional and administrative logics (Chua and Degeling, 1993; Conrad and Uslu, 2011; Covaleski et al , 1993; Doolin, 1999; Jacobs et al , 2004; Kraus, 2012; Lehtonen, 2007; Leotta and Ruggeri, 2012; Malmmose and Kure, 2021). Some researchers have focused on how each of the two logics (health professional and administrative) cooperate by converging towards the other, thereby sacrificing its specific values and beliefs, such as in the phenomenon called hybridisation (Begkos and Antonopoulou, 2022; Kurunmäki, 2004; Lehtonen, 2007).…”