Abstract
Purpose – This paper aims to offer a critical pathway to understanding recent changes and improvements in organizing and managing healthcare – such as the emerging “patient-centred care” (PCC) approach.
Design/methodology/approach – The research is based on fieldwork performed as a mobile ethnography of translations of everyday healthcare work at a Swedish healthcare institution in which an analysis of the significance of contemporary accounting practices for disciplining action and thought was carried out.
Findings – Accounting is increasingly interlinked with medical practices today, with more and more people involved in translating action and thought into accounting-based terms and values at all levels of their work lives; as this happens, accounting “produces” a way of thinking and valuing that even
modifies professional identities. The discipline of medical knowledge is played out differently as accounting-based valuation measures become internalised into the performance of medical professionals and as additionally their images of themselves and their patients change. Patient-centred care is thereby
seen not as a means of generating a pure or positive value for patients, expressed in the form of greater efficiencies and nation-wide performance indicators. The loosely coupled forms of patient-centred care are about how nurses, having translated accounting practices into their work and selves, use them as a means of managing the constraints and “cracks” in the PCC approaches.
Originality/value – Accounting allows the dynamics of the PCC approach to be understood and acted on in new ways. Accounting as a discipline involves both accounting professionals and medical professionals who circulate accounting numbers and values. Accounting, thus, is an activity that takes place inside and outside the self.
Design/methodology/approach – The research is based on fieldwork performed as a mobile ethnography of translations of everyday healthcare work at a Swedish healthcare institution in which an analysis of the significance of contemporary accounting practices for disciplining action and thought was carried out.
Findings – Accounting is increasingly interlinked with medical practices today, with more and more people involved in translating action and thought into accounting-based terms and values at all levels of their work lives; as this happens, accounting “produces” a way of thinking and valuing that even
modifies professional identities. The discipline of medical knowledge is played out differently as accounting-based valuation measures become internalised into the performance of medical professionals and as additionally their images of themselves and their patients change. Patient-centred care is thereby
seen not as a means of generating a pure or positive value for patients, expressed in the form of greater efficiencies and nation-wide performance indicators. The loosely coupled forms of patient-centred care are about how nurses, having translated accounting practices into their work and selves, use them as a means of managing the constraints and “cracks” in the PCC approaches.
Originality/value – Accounting allows the dynamics of the PCC approach to be understood and acted on in new ways. Accounting as a discipline involves both accounting professionals and medical professionals who circulate accounting numbers and values. Accounting, thus, is an activity that takes place inside and outside the self.
| Original language | English |
|---|---|
| Pages (from-to) | 381-391 |
| Number of pages | 11 |
| Journal | International Journal of Public Sector Management |
| Volume | 23 |
| Issue number | 4 |
| Publication status | Published - 2010 |
Keywords
- Accounting, Medical practice, Patient care, Knowledge transfer, Health services, Management accountability, Sweden