Digital Theses Archive


Tesi etd-09282017-111950

Type of thesis
Investigating the role of accounting in healthcare organizations: traditional costing and new approaches
Scientific disciplinary sector
relatore Prof. CINQUINI, LINO
Membro Prof.ssa MORTARA, LETIZIA
  • Nessuna parola chiave trovata
Exam session start date
This dissertation contributes to the literature concerning clinicians’ approach toward accounting information systems (AISs) in healthcare organizations (HCOs) and clinicians’ needs in AISs implementation. <br>AISs have gained increasing relevance in healthcare since organizations have been required to provide data that support planning, monitoring and reporting, with the aims to both allow benchmarking and assessing organizational and individual performance. In this process, clinicians have been also attributed the role of mangers. They have become the recipients of accounting information, thus the provision of data directed at increasing their cost-consciousness in decision making has become a challenge.<br>Since literature shows the clinicians’ negative approach regarding their managerial roles, a broad body of research has deepened the factors hindering their full involvement in management and incentivizing their resistance toward accounting. This body of literature claimed for an investigation of the causes that, three decades after the enhancement of managerial reforms, still hinder clinicians’ full involvement in management and prevent them from using AISs in healthcare organizations. In fact, whether literature deepened both contextual and organizational factors affecting clinicians’ resistance to AISs, space for action remains with reference to the exploration of this issue at organizational level.<br>The current research aims at deepening this issue. Following literature’s call, the research adopts a narrow focus on the organizational factors and answers the following main research question: Which factors can foster clinicians’ resistance to accounting information systems or can increase clinicians’ use of accounting techniques in healthcare organizations? <br>To this aim, this dissertation first analyses the literature in the field to identify the most relevant themes emerging and the topics requiring further investigation. <br>Second, the dissertation explores, by empirical analysis, the main factors that appear to affect clinicians’ resistance to accounting in healthcare: (a) the patterns of collaboration between clinicians and controllers in the design of AISs; (b) clinicians’ perception of AISs adaptability to their information needs, according to the type of organization in which clinicians work and their medical education. <br>The dissertation is divided into three parts, which contribute theoretically and empirically to answer the main research question.<br>The first step consists of a systematic literature review that explores the high-quality accounting, management, and social sciences literature with the aim to identify the main issues related to clinicians’ resistance to AISs in HCOs and the organizational factors that exacerbate or hinder clinicians’ involvement in management. To this trail, the review examines 79 papers and allows at detecting the topics investigated and the trend of publication over time, and to identify the main factors that affect clinicians’ approach to accounting and require further investigation. Three main streams of research emerged: (i) relationships between clinicians and controllers, (ii) the characteristics of AISs that may increase clinicians’ involvement in management, and (iii) medical education. The review’s findings result in a series of hints for the development of the empirical stages of the research, which are conducted investigating the Italian setting, and adopting both qualitative and quantitative approaches. The following steps deepen the above three factors by empirical investigation. <br>The second step of this dissertation consists in a case study conducted in a single organization and directed at investigating whether clinicians and controllers collaborate in the design of AISs. Interviews with both controllers and clinicians reveal that the coercive control coming from regulations has challenged controllers’ autonomy and changed their role in the organization. In this sense, controllers appear to be less focused on performing an actual management control and more committed to the design of AISs that satisfy normative requirements, while they fail in providing clinicians with valuable accounting information for decision-making. It emerges that the characteristics of accounting techniques implemented in HCOs differ from those who may increase clinicians’ managerial approach.<br>The third step of the research presents a survey directed at assessing clinicians’ perception of accounting systems’ adaptability to their needs. The research, in particular, explores the impact of two factors on clinicians’ perceptions of AISs adaptability: HCOs structural configuration, in terms of decentralization of decisional processes and involvement of clinicians in the design of AISs that fit their needs, and clinicians’ medical education. The survey has been conducted among 304 clinicians working in Local Health Authorities and independent hospital in six Italian regions. Results show that the differences between the two structural configurations are not significant. However, when accounting techniques’ capability to adapt to more patient-focused approaches is considered, AISs in independent hospitals are perceived more adaptable. It emerges that independent hospitals’ characteristics allow at involving more clinicians in decision making and at designing AISs that are more consistent with clinicians’ needs. In addition, the survey provides evidence of the differences between surgeons and other clinicians, and of surgeons’ lower perception of AISs adaptability. This supports the idea of the existence of a surgeon stereotype that influences clinicians’ accounting choices and their willingness to be involved in management.<br>The three steps allow at answering the main research question, extending the knowledge in accounting literature of the factors that affect clinicians’ approach to accounting in healthcare organizations. The research address literature’s call for an investigation of the organizational factors that hinder clinicians’ involvement in management. The study identifies the factors that worth further research in this sense, and then empirically deepens these factors. It contributes to increase accounting’s knowledge about the patterns of collaboration between clinicians and controllers, the characteristics of AISs that increase clinicians’ involvement in management and the effect of medical education on clinicians’ approach to accounting. In this sense, the study contributes to accounting literature using both qualitative and quantitative methods, and highlights the inadequacy of existing AISs and the scarce involvement of clinicians in the design of AISs, as a consequences of strict regulations and the centralization of decision making processes. Furthermore, it explores the impact of structural configurations and medical education on clinicians perception of AISs adaptability to the changes occurring in HCOs. <br>Future researches could investigate the relevance of the themes emerging in this research in other contexts with different characteristics. Research is also needed to deepen how medical education can increase clinicians’ willingness to assume managerial roles, and how organizations can push clinicians toward accounting, while decentralizing decisional processes and incentivising controllers to involve clinicians in AISs design.