An institutional theory perspective on the DRG framework, case-mix accounting systems and health-care organizations

Case-mix accounting systems have been advanced as both reflecting the economic reality that underlies a hospital's various “product lines”, as defined by DRG prospective payment categories, and facilitating rational decision making regarding resource acquisition, deployment and use. This article uses the institutional perspective to extend this conceptualization of case-mix accounting systems. The institutional perspective proposes that many elements of organizational structure, like case-mix accounting systems, reflect as much a need to conform to societal expectations of acceptable practice as the technical imperative of fostering rationality. This article also extends institutional theory regarding the issues of power and decoupling by considering institutionalization to be an unfinished process in the health-care context, wherein the active agency of individuals and organizations is subjected to systematic examination. In this specific context, case-mix accounting may play a significant role in establishing and perpetuating — not merely supporting — the very social structure of legitimacy, and may consequently be considered an interest-oriented activity having the potential to penetrate and alter the internal operating processes of financially strained hospitals.     

Inflation accounting in a theory of calculation

How should we conceptualize the issue of inflation accounting? This is the problem raised and discussed in this paper. It represents a case study of the recent U.K. inflation accounting debate, but tries to set this within the context of how financial calculation more generally is organised and its social determinants. Two particularly distinctive features of the analysis are the ways in which this debate is related to the idea of financial calculation as “sign”, and the non-reduction of the “interests” located in the debate to expressions of some pre-given social position. Finally the wider implications of this non-orthodox approach are assessed.     

Constructing, persuading and silencing: the rhetoric of accounting standards

Members of the Financial Accounting Standards Board (FASB) and its staff are continuously engaged in a variety of efforts to persuade individuals that the work of this entity is valuable, appropriate, useful and correct. In this paper, I focus upon the persuasive efforts that are employed in “official” accounting standards. These documents do more than simply detail new technical accounting requirements. The texts have been shaped to express a particular point of view about the significance of events and activities that occurred during the standard-setting process and contain numerous efforts to persuade readers to accept this perspective. In particular, I argue that the FASB employs rhetorical strategies in its accounting standards that construct (and attempt to persuade us) that a specific standard is “good”, that silence alternatives and possible criticisms of the standard and that construct the FASB as a “good” standard-setter. These strategies help to construct standards as technical products and thereby also work to maintain the myth of accounting objectivity.     

A writing intervention for the accounting classroom: dealing with the problem of faulty modifiers

Good communication skills continue to be viewed as critical for success in accounting. This paper demonstrates a writing-skills “intervention” that deals with faulty modifiers, a grammatical problem that can inhibit accounting students and professionals from achieving the clarity and conciseness widely regarded as essential in the accounting profession. The intervention consists of a handout distributed to students – fashioned to sensitize them to the pervasiveness of faulty modifiers and help them avoid the problem – and an in-class discussion of the handout. By design, this intervention is both inexpensive and unobtrusive. For the accounting instructor, we provide in the body of the paper a technical, but unpedantic and informal, analysis of faulty modifiers, including numerous examples of the problem, accompanied by alternative corrections. To date, few papers in the accounting education literature that deal with writing problems present direct assessment evidence. To assess the efficacy and perceived value of our learning intervention, we collected assessment data – both direct (i.e., a set of three diagnostic tests) and indirect (i.e., feedback from a student questionnaire) from two institutions at which our learning intervention was tested. These data suggest than an intervention of the sort described here can be valuable in remedying discrete weaknesses of student writing. In a larger sense, we believe our paper can be used as a model for the development of similar “interventions” that cover other grammatical problems, and that can serve either as stand-alone entities (similar to the method proposed by Reinstein and Houston (2004) [Using the Securities and Exchange Commission’s “plain English” guidelines to improve accounting students’ writing skills. Journal of Accounting Education, 22, 53–67]) or as complementary resources to more comprehensive and formal writing programs.     

Accounting as a legitimating institution

Recent attempts to reconceptualize the role of accounting in organizations and society have suggested that accounting may be examined as a “legitimating institution”. The concept of legitimation, however, has not developed within a single theoretic tradition, rather it emerges from three sociological traditions, each suggesting a distinct perspective on the phenomena and opening new areas for research. This paper reviews perspectives on legitimation, locates existing research on accounting within them, and suggests some areas for further research.     

Accounting and the examination: A genealogy of disciplinary power

Historical elaboration of Foucault's concept of “power-knowledge” can explain both the late-medieval developments in accounting technology and why the near-universal adoption of a discourse of accountancy is delayed until the nineteenth century. It is the disciplinary techniques of elite medieval educational institutions—the new universities and their examinations—that generate new power-knowledge relations. These techniques embody forms of textual rewriting (including the new “alphanumeric” system) from which the accounting advances are produced and “control” is formalised. “Double-entry” is an aspect of these rewritings, linked also to the new writing and rewritings of money, especially the bill of exchange. By the eighteenth century accounting technologies are feeding back in a general way into educational practice (e.g. in the deployment of “book-keeping” on pupils) and this culminates in the introduction of the written examination and the mathematical mark. A new regime of “objective” evaluation of total populations, made up of individually “calculable” subjects, is thereby engendered and then extended — apparently first in the U.S. railroads — into modern comprehensive management and financial accounting systems (systems of “accountability” embodying Foucault's “reciprocal hierarchical observation” and “normalising judgement”), while written examinations become used to legitimate the newly autonomous profession of accountancy.     

Towards an understanding of the phases of goodwill accounting in four Western capitalist countries: From stakeholder model to shareholder model

The objective of this paper is to illustrate that the change in shareholders’ attitude towards firms (from stakeholder model to shareholder model) influences the accounting treatments of goodwill. Our study is based on four countries (Great Britain, the United States, Germany, and France) and covers more than a century, starting in 1880. We explain that all these countries have gone through four identified phases of goodwill accounting, classified as (1) “static” (immediate or rapid expensing), (2) “weakened static” (write-off against equity), (3) “dynamic” (recognition with amortization over a long period) and (4) “actuarial” (recognition without amortization but with impairment if necessary). We contribute several new features to the existing literature on goodwill: our study (1) is international and comparative, (2) spans more than a century, (3) uses the stakeholder/shareholder models to explain the evolution in goodwill treatment in the four countries studied. More precisely, it relates a balance sheet theory, which distinguishes four phases in accounting treatment for goodwill, to the shift from a stakeholder model to a shareholder model, which leads to the preference for short-term rather than long-term profit, (4) contributes to the debate on whether accounting rules simply reflect or arguably help to produce the general trend towards the shareholder model, (5) demonstrates a “one-way” evolution of goodwill treatment in the four countries studied, towards the actuarial phase.     

Adopting commercial software in the accounting classroom: A focus on learning

Concerns about the current state of accounting education are well documented. A common anxiety is that students are not prepared to deal with the complex issues and unstructured problems that they will encounter throughout their professional lives. Recent studies conclude that an educational objective for accounting is to teach students how to learn. This paper discusses adopting commercial-use software as an approach to accomplish this objective. The paper also provides an example for an accounting information systems class. Because “learning to learn” involves teaching students learning strategies, accounting educators need to find new ways to help students acquire these strategies. This paper will be useful for instructors seeking ways to assist students in developing strategies for learning that will better prepare them for careers in a complex and dynamic environment.     

Teaching ideas for the commencement of the governmental accounting source

Many undergraduate accounting students enter their first course in governmental accounting with a negative attitude about the subject. This is due, in part, to the fact that after several courses in “accounting,” the governmental course presents methods and procedures which are quite different and are, therefore, suspect. This paper encourages an approach to the course which can overcome this bias by providing an appropriate context from which to commence the course.     

The average hospital

In 1998, the UK government introduced the National Reference Costing Exercise (NRCE) to benchmark hospital costs. Benchmarking is usually associated with “excellence”; the government emphasised the raising of standards in the 1997 White Paper “The New NHS: Modern, Dependable” that heralded the NRCE. This paper argues that the UK “New Labour” government's introduction of, and increasing reliance on, hospital cost benchmarking is promoting “averageness”. Average hospitals will be cheaper to run and easier to control than highly differentiated ones; they may also score more highly on certain measures of service improvement. The paper aims, through empirical investigation, both to demonstrate how the activities and processes of hospital life “become average” as they are transformed to comply with the cost accounting average and to indicate how the “average” is being promoted as the norm for hospitals to aspire to. To benchmark to average costs, comparisons are necessary. To compare hospital costs involves the creation of categories and classification systems for clinical activities. Empirical evidence shows that as doctors, patients and clinical practices are moulded into costed categories, they become more standardized, more commensurate and the average hospital is created.     

The very idea of classification in international accounting

The paper discusses some issues and problems associated with attempts to classify national systems of accounting. Attention is given to classification experiences in other disciplines. The analysis aims to show the incoherence of taxonomies which rely upon appeals to objectivity and tries to present a case for the development of classifications which explicitly focus on the concept of an “accounting system”.     

“The everyday accountant and researching his reality”: Further thoughts

It is the contention of this paper that accounting researchers have been dominated in thier research methodology by methods supposedly adopted from the natural sciences. It is argued that it is time that attention was paid to the possible use of radically different “naturalistic” (or “interpretive humanistic”) research approaches in order both to focus research more closely on the concerns of practitioners and to give greater insight into everyday effects of accounting and the practices of accountants themselves.     

Towards a critical understanding of accounting: The case of cost accounting in the U.K., 1914–1925

Management accounting is commonly understood to be a set of techniques for collecting and processing useful facts about organisational life. The information obtained is viewed as an objective form of knowledge untaited by social values and ideology; the practitioners as technically skilled professionals whose political and social allegiances have no bearing on their practices. In this paper these views are brought into question through the “genealogical” method of looking in detail at one period in the history of accounting, examining the interplay between knowledge, techniques, institutions and occupational claims. In the period and place chosen — Britain during the First World War and the immediately following years, society was in a state of turmoil and this provides an ideal context for considering one part of the genealogy of management accounting.     

Time and space in income accounting

Inspired by the work of DR Scott, we explore the formation of an internal logic of income accounting that bestows upon the income accounting system an institutional status. As large scale modern corporations emerged in the market, imaginative ways of doing income accounting were developed and exercised in the 19th century. Creative accounting practices of the time were eventually evolved into what is now known to be the accrual process. A distinctive feature of the accrual accounting system, that has the accrual process as its essential part, is that it creates internal space demarcated (de-marketed) from the external world. In the demarcated space of the accrual accounting system, “the Emptying-out of Internal Transaction Time” takes place. Internal transactions enable the accrual accounting system to generate smoothed income series out of cashflow chaos, which function as an “attractor” in the complex relationships between managers and stakeholders. Creative accounting practices induced phase transition so as to establish the accrual accounting system as a legitimate social institution.     

Microcomputer competency requirements in the accounting industry: A pilot study

The significant changes in the accounting environment resulting from the expanding use of microcomputers suggests a need for an evaluation of the changing requirements placed on universities in educating accounting students. The purpose of this paper is to update information on how microcomputers are being used in public accounting and in industry and to report on the investigation of the resulting microcomputer competency requirements as defined from the perspective of those companies.There have been many attempts to define computer literacy (or competency) from a pedagogical point of view (see Barger [1983]). Herbert Simon [1983] explained the term, computer literacy, as a part of “a broader problem that has been with us for a long time … the problem of quantitative literacy for the population of the technical world.” Ijiri [1983] saw the problem as one of moving from illustrative methods of teaching that rely on the students' inductive abilities to the “algorithmic” method of instruction that utilizes the computer's powerful deductive abilities. In this study, however, microcomputer competency is defined in terms of the specific requirements of the accounting industry. The depth and breadth of desired knowledge for graduating accountants relating to broad microcomputer topics as well as specific concepts considered important by prospective employers are investigated. The normative question of curriculum development is not discussed, although the information presented may assist those involved in developing curricula in reaction to this important change in the accounting environment.     

Accounting for the control of doctors: Management information systems in hospitals

The paper describes some current and proposed innovations in the activity accounting and cost accounting systems in two Swedish hospitals. Results are reported of interviews with administrators and senior doctors which reveal their attitudes and intensions with respect to the new control information generated by the accounting innovations. The fundamental differences between the professional ethos of the doctor and the managerial ambitions of the administrator are found to remain robust. Nevertheless there is evidence that the new control information may be the focus of some genuine convergence in the outlook of some administrators and some “doctors managers” with some consequent reduction in goal-uncertainty in the organisation. This paper argues that this calls for some revision of existing accounts of the interaction of doctors and administrators in hospital management.