"Comparing the incomparable":hospital costing and the art of medicine in post-war Britain

This paper examines the relationship between medical and hospital accounting discourses during the two decades after the 1946 National Health Service (NHS) Act for England and Wales. It argues that the departmental costing system introduced into the NHS in 1957 was concerned with the administrative aspects of hospital costliness as contemporary hospital accountants suggested that the perceived incomparability, immeasurability and uncontrollability of medical practice precluded the application of cost accounting to the clinical functions of hospitals. The paper links these suggestions to medical discourses which portrayed the practice of medicine as an intuitive and experience-based art and argues that post-war conceptions of clinical medicine represented this domain in a manner that was neither susceptible to the calculations of cost accountants nor to calculating and normalising intervention more generally. The paper concludes by suggesting that a closer engagement with medical discourses may enhance our understanding of historical as well as present day attempts to make medicine calculable

Individual responses to competing accountability pressures in hybrid organisations: The case of an English business school

Purpose: The purpose of this paper is to examine conflicting institutional demands on individual frontline employees in hybrid public sector organisations. Specifically, it examines the competing accountability pressures professional and commercial logics exerted on academics at a business school, how individual lecturers responded to such pressures, and what drove these responses. Design/methodology/approach: The paper draws on a case study of an English business school and is informed by the literatures on institutional logics and hybrid organisations. Findings: The paper shows that the co-existence of professional and commercial logics at the case organisation exerted competing accountability pressures on lecturers. It moreover shows that sometimes deliberately and purposefully, sometimes ad hoc or even coincidentally, lecturers drew on a wide range of responses to these conflicting pressures, including compliance, defiance, combination and compartmentalisation. Originality/value: The paper sheds light on individual level responses to competing institutional logics and associated accountability pressures, as well as on their drivers. It also highlights the drawbacks of user, customer or citizen accountability mechanisms, showing that a strong emphasis on them in knowledge-intensive public organisations can have severe dysfunctional effects

Management as ideology: ‘new’ managerialism and the corporate university in the period of COVID-19

In this paper, we examine how Covid-19 was utilized by the management of a university as a catalyst for ideological change, with the objective of transforming the ethos of a university management school and the role(s) of the academics employed within. Through new modes of working that maintained corporeal distance between university staff, market-based ideology was mobilized to institute radical and lasting change within the roles of academics and operations of the institution. We focus on a singular case study: “Blue Management School” (BMS, pseudonym), based within an English mid-tier research university which has historically embraced corporatization more readily than most of its peers. We conducted a qualitative analysis of management email communications and from interviews with nine academics (both current and former employees) who were working at BMS during the time concerned (March 2020 onward). We observe that Covid-19 posed significant challenges to corporatized universities, and that university managers at BMS sought to address these challenges by undertaking further steps toward corporatization and mobilizing organizational change legitimized by the need to manage the Covid-19 situation. This included hierarchical forms of accountability, with academics answering for module content to teaching convenors and the management team (“manager academics”). We draw attention to how management communications carried profound effects for the mobilization of ideological change within the institution, during this period. In addition, academic identity was affected, moving away from traditional research and teaching scholars toward revenue-generating customer service workers, facilitating a power shift away from academics and further toward managers

Social accounting in the context of profound political, social and economic crisis: the case of the Arab Spring

Purpose This paper explores how social accounting operates in the context of profound political, social and economic crises. Specifically, it examines how companies constructed strategies of action to produce and organise social accounting practices under different sociopolitical and economic contexts prior to and after the Arab Spring. Design/methodology/approach The paper draws on Swidler's theory of “Culture Toolkit” and 43 semi-structured interviews with 17 firms and their stakeholders in the Arab region. Findings The study argues that context influences social accounting practices by shaping a cultural toolkit of habits, skills and styles from which companies develop their social accounting related strategies of action. During “settled” periods, companies draw on resources to develop their social accounting practices whilst they seek knowledge and feedback on boundaries and expectations of the socio-political and economic contexts. During “unsettled” periods, companies begin to adopt highly organised meaning systems (i.e. ideologies) from which new ways and methods of social accounting practices are deployed. Originality/value The paper contributes to the extant literature by providing insights into social accounting practices in the under-explored context of the profound political, social and economic crises that followed the Arab Spring. In addition, we introduce Swidler's Culture Toolkit theory to the accounting literature

From ‘rock stars’ to ‘hygiene factors’:teachers at private accountancy tuition providers

In this paper, we examine the role, status and autonomy of teachers at English private accountancy tuition providers from 1980 to the present. We argue that, during this period, teachers transformed from ‘rock stars’ who enjoyed significant status and autonomy over their work to ‘hygiene factors’ in a largely standardised and commodified teaching environment. Growing cost pressures on tuition providers and an increasing emphasis on the quality and consistency of the learning experience are identified as significant factors in this transformation. We discuss these findings with reference to current developments towards corporatisation and marketisation in the English higher education sector

Accounting and the emergence of care pathways in the National Health Service

This paper examines the effects of New Public Management reforms on the information infrastructure underpinning the work of public service professionals. Focussing on the case of the British National Health Service (NHS), the paper argues that hospital accounting reforms played a significant role in the emergence of standardised models of clinical practice. The paper moreover argues that, under the label “care pathways”, such standardised models of clinical practice became embedded in the information infrastructure of the NHS and concludes by discussing their implications for the work of doctors and hospital accountants

Making medicine calculable : hospital costing between the art and the science of medicine

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