Decision Logics by Nurse Leaders: A Case Study of the Use of Accounting Information in a British Columbia Health Authority

Abstract

The role of surgical nurse leaders within the health system of British Columbia is relatively unique. For, in addition to important medical issues, they are also largely responsible for financial budgets, output targets and key performance Indicators. The research determines insights as to how management accounting and related information systems influence surgical nurse leaders’ decision logics and their interactions with surgeons and other surgical professionals.The research employs a case-study using primarily semi-structured interviews and documentation review. Two theoretical frames are deployed for the research. The first is Institutional Theory as a possible trans-disciplinary explanation that challenges rational decision making. The second is Actor-Network Theory with the possibility that “networks” may supplement, sustain or collapse institutional forms.Key findings point to the limited accountability of surgeons and the importance of a selective range of surgical output incentives including a “fee for service” regimen of remuneration. Where common interests are established, persuasive power, judiciously applied by nurse leaders was found to significantly influence the medical practices of surgeons.The scope of the research was tempered by the relatively modest inputs from surgeons and surgical leaders. A more comprehensive study with greater input from surgeons would likely be more revealing and informative.Resource pressures on B.C. Health Authorities are intense and increasing. The research informs policy makers responsible for the design of cost controls, output incentives and key performance Indicators.