Context, culture and control: a case study on accounting change in an Italian regional health service

Abstract

The current paper relies upon Broadbent and Laughlin’s (Manag Account Res 20(4):283–295, 2009, Accounting control and controlling accounting: interdisciplinary and critical perspectives, Emerald, Bingley, 2013) notion of culture, context, and steering mechanisms to understand how context and culture mould PMS change in healthcare switching from one pathway to another. It employs the case study of an Italian regional health service carried out over a 3-year period (2010–2013) with 25 semi-structured interviews with relevant actors (regional councillors, CEOs of healthcare organisations, and physicians that are heads of health departments), and including the retrospective collection of data on the period 2005–2009 through respondents’ views supported by secondary data. The findings show a switch from the reorientation trough absorption response of the first period (2005–2009) to the reorientation trough boundary management towards evolution response of the second period (2010–2013). They highlight that this is the result of a change in context and the leading rationalities towards a policy based on cooperation and stakeholder dialogue through the development of a common language helping to supersede previous inability to interact. It enlightens that the change in the RHS came about in the wake of a hybridisation of all the actors involved which can be construed as an enlargement in their interpretive schemes happening at the individual level and influencing the organisational level. In the study RHS the change in context and culture favoured the formation of a managerial logic and an enrichment of the value system of the organisation towards a well-functioning PMS. In turn the PMS daily helps to reinforce the cooperative and dialogic approach, prompting a virtuous circle, and offering broader insights relevant to theory, practice, and the policymakers.