Involved accounting and control in health care
The purpose of this study is to explore why and how Management Accounting and Control Systems (MACS) enact and are enacted upon in the Dutch branch of nursing homes, homes for the elderly and home care. In search for answers, this study chooses an actor-network theory (ANT) perspective combined with case study research as research frames. Central theme in ANT is the theory of translation. This theory offers opportunities for a close empirical inspection of how and why MACS enact and are enacted upon by other actants in a complex set of sociotechnical relations. The theory of translation is applied in a case study research at The Relief Group (TRG), a healthcare organization which comprises a total of 10 nursing homes and homes for elderly. This case study shows how the application of MACS expands both in numbers of employees involved and in amount of information. Due to an increase in perceived environmental uncertainty and reorganization to a more decentralized model of management all TRG management levels asked, to varying degree, for broad application of MACS information in general and for non-financial information in particular. This initiated a process in which MACS did not diffuse unchanged but was manipulated and aligned with different interests of various stakeholders. At first sight, the TRG case study reveals MACS as a boundary object. In second instance however, this study questions whether this epistemological point of view, denoting the differences between the various TRG stakeholders as differences in interpretation and perception, obscuring an optimal application of MACS, offers sufficient in-depth understanding. Therefore this study draws on post ANT studies and chooses an ontological point of view, delineating MACS as different objects, enacted in different sets of relations and contexts.
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