Financial Accountability and Management · 1997 · 148 citations · 0 references
Health AdministrationPractice ManagementClinical Decision-makingAccounting PracticeHealth Care AccountingAccounting ControlsHealth Care FinanceHealth Care ManagementNhs CliniciansManagementManaged CareInsurance RegulationsPublic HealthAccounting ProblemAccounting InformationHealth PolicyAccountingMedical ManagersNursingMedical EthicsHealth Care ReimbursementAccounting PolicyPatient SafetyBusinessHealth Services ManagementAccounting RuleClinical Directors
NHS reforms prompted clinical directors and medical managers to expect that accounting information would become a central instrument of institutional control. In practice, clinical directors were uncomfortable with formal accounting controls and had only modest understanding, medical managers were more receptive, but both groups were frustrated by inaccurate and delayed reports, leading cost savings to arise mainly from professional attitudes rather than accounting data and leaving non‑financial controls as the dominant operational mechanism.
Clinical directors and medical managers expected accounting information would assume high importance for institutional control as a consequence of NHS reforms. However, clinical directors were not comfortable with the symbolism of formal accounting controls. Their individual understanding of accounting information varied, but was modest overall. Medical managers were more inclined to accept and respond to financial controls. However, acceptance and response was frustrated for all users by inaccuracy and lateness of accounting reports. Cost savings were prompted more by established professional attitudes than in response to accounting reports. Non‐financial controls remained the dominant mode of operational control.