Financial Control by Nurse Leaders in a British Columbia Health Authority

Abstract

This paper examines managerial accounting change and its effects on a group of nurse leaders responsible for surgical activities in four acute care hospitals inside a large Health Authority (Western Health) located in British Columbia, Canada. This is a qualitative study that relies upon semi-structured interviews with nurse leaders and others and that also makes use of meeting observation and documentation review. At Western Health budgetary responsibility for surgical operations resides with nurse leaders. Over the past 20 years or so, Canadian nurses have become deeply embedded in the process of managing and operating hospitals (Rankin and Campbell, 2006). This research scrutinises how the nurse leader group has been impacted by managerial accounting change and examines how their relationship with physician colleagues impacts on their resource management responsibilities. In Western Health the vast majority of physician leaders have no contractual responsibilities for budget or resource management in general which raises issues of incentives and creates a focus for conflict. A key finding of the study was the significant limitations on operational effectiveness that arose in part from current contractual arrangements.The research is informed by institutional theory and draws upon the frameworks developed by Burns and Scapens (2000, Scapens, 1994). It aims to provide new insights into accounting and control systems in a hospital acute care environment. The study is especially relevant to policy makers at the current time who are faced with the combination of escalating acute care costs and large budget deficits.