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Journal of Management and Governance
Published in: Journal of Management and Governance 1/2020

04-03-2019

Context, culture and control: a case study on accounting change in an Italian regional health service

Authors: Rosanna Spanò, Adele Caldarelli, Luca Ferri, Marco Maffei

Published in: Journal of Management and Governance | Issue 1/2020

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Abstract

The current paper relies upon Broadbent and Laughlin’s (Manag Account Res 20(4):283–295, 2009, Accounting control and controlling accounting: interdisciplinary and critical perspectives, Emerald, Bingley, 2013) notion of culture, context, and steering mechanisms to understand how context and culture mould PMS change in healthcare switching from one pathway to another. It employs the case study of an Italian regional health service carried out over a 3-year period (2010–2013) with 25 semi-structured interviews with relevant actors (regional councillors, CEOs of healthcare organisations, and physicians that are heads of health departments), and including the retrospective collection of data on the period 2005–2009 through respondents’ views supported by secondary data. The findings show a switch from the reorientation trough absorption response of the first period (2005–2009) to the reorientation trough boundary management towards evolution response of the second period (2010–2013). They highlight that this is the result of a change in context and the leading rationalities towards a policy based on cooperation and stakeholder dialogue through the development of a common language helping to supersede previous inability to interact. It enlightens that the change in the RHS came about in the wake of a hybridisation of all the actors involved which can be construed as an enlargement in their interpretive schemes happening at the individual level and influencing the organisational level. In the study RHS the change in context and culture favoured the formation of a managerial logic and an enrichment of the value system of the organisation towards a well-functioning PMS. In turn the PMS daily helps to reinforce the cooperative and dialogic approach, prompting a virtuous circle, and offering broader insights relevant to theory, practice, and the policymakers.
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Appendix
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Footnotes
1
In accordance with Broadbent and Laughlin (2009) performance management system is used here as a general descriptor of management accounting system in this research.
 
2
The label Alfa is used for privacy purposes to avoid disclosing the name of the region.
 
3
Ferreira and Otley (2009) made a first attempt to encompass culture and context to interpret accounting changes. They emphasise some issues relevant for designing and operating a control system, providing a robust and quick outline of the main features constituting a PMS. Actually, contextual factors (environment, size, technology and ownership structure) and culture are not explicitly included in their framework but are considered to explain why specific patterns of control are more or less effective.
 
4
Habermas broadly defines culture as the ensemble of enabling conditions for problem solving activities. He highlights that “a culture furnishes those who grow up in it not only with elementary capacities for speaking, acting and knowing, but also with grammatically pre-structured worldviews and semantically accumulated stocks of knowledge. And what is most important in our context, a culture cannot be maintained through drills and full-blown indoctrination; neither can it be maintained solely through the implicit habituation of the young into appropriate language games and practices. Rather, traditions prove their viability by threading their way into the dispersed and networked channels of individual life histories and, while doing so, passing the critical threshold of the autonomous endorsement of every single potential participant” (Habermas 2005, p. 22). The essentially political character of culture represented for Habermas a constant attempt to reformulate the dialectical relationship of the socio-cultural and political systems (Hohendahl and Silberman 1979). His concern is to explain the transformation of cultural institutions through change in the political system, whose development in turn is conceived through changes in the economic system. Central to this formulation are the notions of rational discourse and communicative interaction that, thanks to the intersubjective agreement on values and standards, can be used to resolve practical questions (Hohendahl and Silberman 1979; Power and Laughlin 1996).
On this regard, we must admit that the nature of the framework does not allow us to isolate linear and contingent relationships and to say that a specific element of culture is more influential than another. However, Habermas’ broad notion of culture and its political insights, as applied by Broadbent and Laughlin (2013) to the study of accounting change, is particularly suitable to unfold the changing dynamics of the setting analysed in the current paper.
 
5
It is worth noting that, even if we considered the RHS characteristics in terms of governance model, relying upon the available categorisations to ascertain which type of rationality informed the change, we integrated this archival material with the interviews that allowed us to go far beyond the extremes of the commonplace categorisations, and gave us a thorough idea of the phenomenon.
 
6
Italian regulation strictly establishes the type of intervention that are necessary to undertake when a Recovery Plan is set in motion for RHSs. Thus, the actions put in practice in the Alfa Region following the guidelines do not constitute the core of the present paper and do not form part of specific discussion, as they would require a massive description. However, for a deeper analysis of the Recovery Plans and their outcomes in the Italian NHS over the last 10 years it is worth consulting Aimone Gigio et al. (2018).
 
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Metadata
Title
Context, culture and control: a case study on accounting change in an Italian regional health service
Authors
Rosanna Spanò
Adele Caldarelli
Luca Ferri
Marco Maffei
Publication date
04-03-2019
Publisher
Springer US
Published in
Journal of Management and Governance / Issue 1/2020
Print ISSN: 1385-3457
Electronic ISSN: 1572-963X
DOI
https://doi.org/10.1007/s10997-019-09458-0

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