Accountingization, colonization and hybridization in historical perspective: the relationship between hospital accounting and clinical medicine in late 20th century Britain

Purpose: This paper examines the historical background of accountingization, colonization and hybridization in the health services by exploring the relationship between hospital accounting and clinical medicine in Britain between the late 1960s and the early 2000s.

Design/methodology/approach: The paper draws on an analysis of professional journals, government reports and other documentary sources relating to accounting and medical developments. It is informed by Abbott’s sociology of professions and Eyal’s sociology of expertise.

Findings: The paper shows that not only accountants but also elements within the medical profession sought to make the practice of medicine more visible, calculable and standardised, and that accounting and medical attempts to make medicine calculable interacted in a mutually reinforcing manner. Consequently, it argues that a movement towards clinical forms of quantification within the medical profession made it more open to economic calculation, which underpinned hospital accounting reforms and the accountingization, colonization or hybridization of the health services.

Originality/value: The paper demonstrates that a fuller understanding of the relationship between accounting and public sector professions can be developed if we examine their mutual interactions rather than restricting ourselves to analysing accounting’s effects on public sector professions. The paper moreover illustrates instances of intra-professional conflict and inter-professional co-operation, and draws on the sociology of expertise to suggests that whilst hospital accounting reforms have curbed the power of medical professionals, they have also enhanced the power of clinical expertise.