Il costo dell’intervento chirurgico in laparoscopia con l’Activity Based Costing

The purpose of this research is to analyze the role of the Management Control System (MCS) and of the Management Accounting System (MAS) in healthcare (HC) organizations. It aims at studying if and how managerial considerations affect the clinical culture. Results are based on the findings of a research developed within 12 Local Health Authorities (Aziende Sanitarie Locali LHAs) and 4 Teaching Hospital (Aziende Ospedaliere Universitarie THs) in Italian Tuscany Region and address the possibility to develop an alternative model from those of accountingization or legitimation proposed in literature to understand the role of these systems in healthcare. Results highlight that the economic language may assume a great importance in clinicians’ decision making and penetrates into clinical culture. Most important factor affecting results is the development of an alliance between controllers and clinicians, based trust and collaboration. The paper is a contribution to the literature about the role of MCS and MAS in healthcare and it is developed within the schemes traced by Habermas and refined by Laughlin and by Broadbent and Laughlin. The original value stands on the individuation of a model where the “integrative interactive” management model is able to penetrate clinical discourse and the conditions at which it can be developed.Management Accounting Change, Management Control Change, Healthcare Accounting, Professional organization, accountinization, legitimation, Habermas

Management Accounting for Service: A Research Agenda

Purpose – The purpose of the paper is to point out a research agenda for Management Accounting under the emergent Service-Dominant (S-D) Logic. S-D Logic is widely discussed in the field of Marketing, the paper tries to extend S-D Logic in the Management Accounting context and develops some related considerations. Methodology/approach – Service related change in economy and firms raises new challenging issues in management accounting topics such as cost classification, cost structure, cost object, the role of “traditional” accounting tools and models, price-cost relations for pricing decisions. In this paper, we identify several critical research questions that address a tentative research agenda in the field of management accounting to better explore its role within service science. Throughout the paper many different examples are provided in order to support what is sustained. Findings – The conclusions of the paper trace some aspects addressed as core in the distinction between Goods-Dominant Accounting and Service-Dominant Accounting. Considering the new changing service environment, the role of management accounting in providing information to support managerial decision making and control can be widely renewed. Research implications – The paper opens many underexplored topics on Management accounting in the interface with service and traces a research agenda for further research. Originality/value – This is the first paper, after the brief overview on accounting and Service Science provided by Kerr (2008), aiming at understanding the role of Management accounting in the context of S-D Logic.Service-Dominant Logic, Management Accounting, Costing, Measurement, Value.

Designing performance measurement systems in health care: multiple organizational players and their interaction in the case of the prevention services in tuscany.

The designing of a performance measurement system usually involves several players, the number and the role of the players in building new performance measurement tools depending on the features affecting the type of organization. Among them, health care units can be considered as some of the most complex to manage (“Running even the most complicated corporation must sometimes seem like child’s play compared to trying to manage almost any hospital.”, Mintzberg and Glouberman 2001), being based on professionals’ activity. Professionals play a wide span of autonomy and they can resist towards changes and control systems that do not involve them, thus implicating their deep involvement in designing and implementing effective management control devices. Due to this characteristic, the decision makers about measurement systems in public health are not only the politics and top managers at different levels (national, regional and local) but also the professionals at their level. But which are the roles of these players at their organizational levels? Do they play a different role in desing and implementation of a performance measurement system? And which are the interactions among them? The aim of this paper is to answer at these questions through the experience of the design of the so-called Prodotti Finiti system for measuring output and performance of the prevention services in Tuscan health care system. The necessity of this performance measurement system rises from a lack that regards the primary care and the collective prevention services: while in the hospital services the DRGs system has been developed and used as a shared tool to measure output and performance, in the primary care and the collective prevention services there is no shared and uniform way to measure the services provided. The idea of using the Prodotti Finiti (Final Products) as objects of performance measurement of prevention services was born at a local level in 1998; then, in 2006, it was spread to all LHAs by the regional level in order to have a uniform and shared system. The players involved in this initiative have been the local and regional levels as the promoter of the introduction of the Prodotti Finiti system and the groups of professionals as the decision-makers of what products and what elements should have to be measured. In the experience of the design of this system the professionals seem to have been the strongest decisional level: they have decided what were the objects to be measured. The political levels (regionals and local) could choose to limit the analysis to some products (as key performance areas) or to some particular elements of the products but these were second hand choices because strictly linked to the assumptions and the decisions already made by professionals. Although the choice of involving professionals in the design of the measurement system is fundamental for the consensus, it could lead to a limited power of the other decision makers, so confirming the strenght of professionals’ power in designing performance measurement systems in health care organizations.performance measurement, public health, multiple players

Do management accounting systems influence organizational change or vice-versa? Evidence from a case of constructive research in the Healthcare Sector

The paper aims to analyze the process of change of management accounting system (MAS) as a consequence of changes in the complexity of organizational structure in healthcare. It analyzes the process of change of MAS according with the theoretical frameworks of Habermas (1987) and Laughlin (1991).In this organizational changes are seen as the consequence of the interaction between tangible and intangible elements of the organization and between the organization and the external environment. The process of change was not studied from an external standpoint, but through an active participation and contribution of the researchers in the process of change itself. Using a constructive approach, the researchers were actively involved with the actors of the change in developing the process of change, and in facilitating the overcoming of some cultural gaps and resistance which could arise in professional organization. The paper provides empirical insights of the characteristics of the process of change of MAS in a Heath Care setting with a particular focus on aspects characterizing the process of change itself. Finding suggests the importance of putting high attention in the development of the process of change and underlines how the attention to peculiarities of the organization, in to this phase, could make the MAS able to impact on the behaviours and culture of professionals.Management Accounting Change, Healthcare Accounting, Habermas

An exploration of the factors affecting the diffusion of advanced costing techniques: a comparative analysis of two surveys (1996-2005)

The issue of cost calculation has been largely debated in the last years under the pressure of the perceived lost of relevance of the so called "traditional cost accounting approaches". The enthusiasm for new management accounting techniques has often driven most of attention towards technical or theoretical aspects of the proposed new cost models. In particular, Activity-Based Costing (ABC) implementation literature pinpoints a large number of studies that have looked at technical and organizational/behavioral factors that influence effective implementation. Recently a great attention has been paid by researchers on the contingent factors affecting the adoption of advanced management accounting techniques and the influence of the variables that drive towards higher levels of cost system sophistication. The need is felt for insightful studies regarding processes and contingent variables working through time in relation with these changes. Improved analysis can be obtained by undertaking replication studies based on larger number of responses and/or across geographic and cultural borders. Whitin the boundaries of a contingent framework analysis, this paper has provided additional insights into areas relating to factors influencing the level of sophistication of product cost systems in Italy. The paper presents the comparison of two survey results carried on in a ten years distance on the same sample of Italian largest companies. These two long-distance surveys provide the opportunity to assess the changes occurred in the companies that in 1996 declared the adoption of (or the interest in adopting) ABC and Target costing (Cinquini et al., 1999).Moreover, the time elapsed could allow the perception about adopters’ behavior, along different stages of the diffusion process of advanced costing techniques. The research findings pinpoint that only “importance of cost information” and “cost structure”, among the contextual variables considered in the more recent survey responses, are positive and significant in relation with increasing in implementation of advanced costing techniques. This outcome could open to further studies to assess whether or not adopters are moving from a “fad and fashion” behavior of the early stages, to a more rational approach in which the matching between management needs and tools potentiality is maximized.Management accounting innovations, Activity-Based Costing, Target costing, Product costing design, Cost system sophistication, Contingent factors

Intellectual capital communication: evidence from social and sustainability reporting

The purpose of this study is to investigate the level and quality of intellectual capital information communicated through social and sustainability report for a sample of 37 Italian listed company over two years (2005 and 2006). The study use the resource based theory to explain the relationship between corporate social responsibility and intellectual capital. Content analysis is applied through a multidimensional framework composed by three main disclosure profiles(time orientation, nature and type of information) which permits to analyse in depth the quality of intellectual capital information. The results highlight significant and increasing presence of intellectual capital information in CSR reports which is communicated principally in non financial, quantitative and non time specific terms. Human capital is the most reported category followed by relational and organisational capital. There are many similarities between the two typology of report contributing to the ongoing debate on corporate reporting practices.The results suggest that the integration between IC report and CSR report is a plausible issue and that could be useful to enhance the transparency and the understanding of company processes and activities both for internal and external stakeholders. Very few studies have analysed the intellectual capital in CSR report in atheoretical and mono-dimensional way. Moreover the resource base theory has been scarcely applied to explain the disclosure of intellectual capital even if there are several similarities between the two perspectives.intellectual capital, disclosure, social and sustainability reporting, resource based view, corporate social responsibility

Using abm in managing territorial health services: the “home-care”.

In recent years in Italy, as in other European countries, profound changes have been introduced in health care at both the central and the regional levels. Most of them were oriented towards a shift from “hospital-centred” healthcare to healthcare based more on territorial services. This transition pursues two objectives: giving more effective responses to citizens’ needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. Starting from the experiences of the healthcare system of the Tuscan Region of Italy, the paper aims to provide an experience of the ABM approach to measure both output and efficiency of territorial health services. Activity Based Management provides an appropriate method to examine territorial activities and to meet the fact-finding needs of national and regional policy, by considering the issues indicated by the territorial managers of the Tuscan healthcare system and the regional and national experiences in recent years. ABM focuses on managing activities as the route to improving value for users and for the local healthcare unit; this is accomplished by the measurement of activities and resources that determine the costs and performance of territorial services. This approach requires organization and integration of sets of data belonging to different systems such as financial and operational systems. The ABM model is complex but it can be used by policy makers for strategic perspective and for continuous improvement. Moreover, ABM meets managers’ demands, as the Tuscan territorial managers have confirmed in interviews. On the basis of experience obtained in territorial long term homecare , the paper underscores the principal issues arising from the process of conducting an ABM project in territorial health services through strong involvement of healthcare workers. The paper also presents the main outputs achieved.Home care, performance measurement, ABM.

Communicating Intellectual Capital: Evidence from Social and Sustainability Reporting

Since the work of Guthrie & Petty (2000) several studies on intellectual capital (IC) reporting have been made to analyze the company disclosure process both public and private communication channels. Within public communication channels, company annual report is the most used document but in general it shows a low level of IC information. Other analyzed public channels are the initial public offering (IPO) prospectuses (Bukh et al. 2005; Cordazzo, 2007), the intellectual capital statements (Bukh et al., 2001; Mouritsen et al., 2001, 2002) and the web sites (Gerpott et al., 2008), all showing different level of IC information. The aim of this paper is to assess in depth the intellectual capital disclosure (ICD) communicated through social and sustainability reports in a sample of 37 Italian listed companies by a longitudinal content analysis (2005, 2006). IC disclosure (on human, organizational and relation capital) is analyzed in quantitative & qualitative, time dimension and financial & non financial terms in order to analyzed more in depth the ICD process. Findings show an overall increase in all categories of intellectual capital over the two years with a particular relevance for the organizational capital category. Overall the amount of ICD is higher when compared to the majority of previous studies based on annual report and it demonstrates the need to investigate more in depth a wide range of company reports to understand carefully the companies intellectual capital disclosure process and the possibility to integrate intellectual capital report and social and sustainability reporting in a single report.

An exploration of the factors affecting the diffusion of Advanced Costing techniques: a comparative analysis of two surveys (1996-2005)

The issue of cost calculation has been largely debated in the last years under the pressure of the perceived lost of relevance of the so called "traditional cost accounting approaches". The enthusiasm for new management accounting techniques has often driven most of attention towards technical or theoretical aspects of the proposed new cost models. In particular, Activity-Based Costing (ABC) implementation literature pinpoints a large number of studies that have looked at technical and organizational/behavioral factors that influence effective implementation. Recently a great attention has been paid by researchers on the contingent factors affecting the adoption of advanced management accounting techniques and the influence of the variables that drive towards higher levels of cost system sophistication. The need is felt for insightful studies regarding processes and contingent variables working through time in relation with these changes. Improved analysis can be obtained by undertaking replication studies based on larger number of responses and/or across geographic and cultural borders. Whitin the boundaries of a contingent framework analysis, this paper has provided additional insights into areas relating to factors influencing the level of sophistication of product cost systems in Italy. The paper presents the comparison of two survey results carried on in a ten years distance on the same sample of Italian largest companies. These two long-distance surveys provide the opportunity to assess the changes occurred in the companies that in 1996 declared the adoption of (or the interest in adopting) ABC and Target costing (Cinquini et al., 1999).Moreover, the time elapsed could allow the perception about adopters’ behavior, along different stages of the diffusion process of advanced costing techniques. The research findings pinpoint that only “importance of cost information” and “cost structure”, among the contextual variables considered in the more recent survey responses, are positive and significant in relation with increasing in implementation of advanced costing techniques. This outcome could open to further studies to assess whether or not adopters are moving from a “fad and fashion” behavior of the early stages, to a more rational approach in which the matching between management needs and tools potentiality is maximized.Management accounting innovations, Activity-Based Costing, Target costing, Product costing design, Cost system sophistication, Contingent factors

Cost measurement in laparoscopic surgery: results from an activity-based costing application

Activity Based Costing (ABC) techniques are designed to support advanced cost analysis in different organizations. Centred on organization activities and processes, it provides more accurate cost information on cost objects using appropriate cost drivers and constitutes a powerful costing model to improve efficiency and effectiveness in delivering products and services. ABC can be successfully applied also in Health Care organizations, where the patient is the main “object” of the activities performed. In addition, in can be fruitfully used in costing the resource consumption of new medical technology devices or surgery processes to assess their economic impact on health care costs. The purpose of this paper is to describe an Activity based costing model designed to measure and control resources consumption and cost when a new technology is applied in health care processes. An ABC model has been defined in relation to laparoscopic technologies applied to surgical cases, designing a health care “activity hierarchy” based on the processes of a specific local unit organization. The output of the application has been a full cost of laparoscopic surgery to be compared with the correspondent DRG current value. As a further result, the paper shows how the ABC model is able to generate different cost figures referred to activity levels or aggregations able to support decision making especially when the introduction of a new surgical technology has to be economically assessed. Propositions are finally made to generate discussion about the effectiveness of the existing cost accounting systems in the health care organizations and on the need for the wider diffusion of ABC techniques in this service sector.Activity-Based Costing, Economic assessment of surgery techniques