Accounting information can be instrumental to agents who strategize. Pluralistic settings are conducive to strategizing. Although the dynamics between accounting systems and strategic decision-making are well studied in the private sector, little is known about the relationship between accounting and strategizing in the pluralistic setting of healthcare. Hence, this study investigates medical managers' strategizing practices with accounting information (e.g. building cases for investment and taking on new business). Medical managers require, at least, some expertise with accounting to employ it effectively in strategizing. In consequence, the study also explores variation in medical managers' technical knowledge of costs and level of engagement with accounting information. Thus, this research answers the question of how medical managers strategize with accounting information. The study draws upon accounting and strategizing literature, which interrogates actors' strategizing practices (e.g. Paroutis & Pettigrew, 2007), the artefacts and tools that they mobilise while strategizing (e.g. Jarzabkowski et al., 2013) and how accounting and strategizing helps actors contextualize strategic objectives and accounting concepts (e.g. Jørgensen & Messner, 2010). In doing so, accounting and strategizing studies shift away from viewing strategy as a black box (Chua, 2007; Johnson et al., 2003). This study focuses on Clinical and Medical Directors; clinicians who have both medical and managerial responsibilities. This hybrid profession is increasingly important for health care organizations, however, in the past, clinicians' competence and engagement with accounting information has not been widespread (Llewellyn, 2001; Kurunmäki, 2004).The research uses a mixed methods approach to gather and analyse empirical data. Interviews were held with Clinical and Medical Directors at four selected Trusts that demonstrated a high level of engagement between finance professionals and clinicians at different organizational levels and across all clinical specialties (Department of Health, 2013). Documentary analysis examined the use of accounting information in business cases for investment, annual strategy plans and specialty reports. A survey explored the financial training, engagement and use of accounting information for the whole population of Clinical and Medical Directors of all NHS Trusts in England. The study finds that medical managers strategize via controlling, contesting and competing (C-C-C) practices. Specifically, they strategize with accounting information to control activity and expenditure, contest imposed costs, and compete, against others, for resources. In doing so, they embed accounting in business cases, bubble charts and performance reports, using these as artefacts and tools, to display the practical and general understandings of accounting which inform their strategizing practices. Thus, for pluralistic settings like healthcare, the study introduces a theoretical 'C-C-C' typology to the notion of strategizing and makes an empirical contribution to how actors strategize with accounting information.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-07-06T17:48:35Z No. of bitstreams: 1 Maiane Bertoldo Lewandowski.pdf: 2043206 bytes, checksum: f6837d0e0b8c09202484655867eac535 (MD5) / Made available in DSpace on 2015-07-06T17:48:35Z (GMT). No. of bitstreams: 1 Maiane Bertoldo Lewandowski.pdf: 2043206 bytes, checksum: f6837d0e0b8c09202484655867eac535 (MD5) Previous issue date: 2014-05-12 / Nenhuma / Nas instituições hospitalares, a divisão entre áreas fins (do negócio) e áreas meio (administrativas), repercute na gestão entre duas instâncias: especialistas gestores e gestores administrativos. Historicamente, os médicos vêm ocupando posições executivas nessas instituições, no entanto, ser gestor não costuma ser um desejo ou motivador para os médicos, que encontram seu reconhecimento na especialidade médica escolhida. Em contrapartida, as instituições hospitalares, ao mesmo tempo, têm o desafio de formar, constituir identidade e desenvolver líderes (de formação técnica) na busca de criação de valor. Portanto, neste estudo, procurou-se identificar e analisar que elementos são necessários à preparação dos médicos e das organizações hospitalares nas situações onde os primeiros são designados a funções executivas. Com esse intuito, a pesquisa realizada é de caráter exploratório, tendo como estratégia a pesquisa de campo. Foram realizadas entrevistas qualitativas, semiestruturadas, com 21 gestores médicos que atuam em instituições hospitalares ligadas à ANAHP – Associação Nacional dos Hospitais Privados. Essas instituições de saúde privadas abrangem quatro Estados brasileiros: RS, SP, MG e DF. Todas as entrevistas realizadas foram gravadas em áudio, transcritas para texto e categorizadas, sendo organizadas e analisadas por meio do software de pesquisa qualitativa NVivo 10®. Para discussão e interpretação dos dados de pesquisa, utilizou-se a análise de conteúdo, englobando a análise textual discursiva. Os resultados foram organizados em quatro unidades de análise: integração do gestor médico na cultura hospitalar, compreensão do processo de empoderamento dos médicos nas funções executivas, discussão da identidade profissional do gestor médico e a sinalização de fatores e práticas que contribuem para retenção e desempenho dos médicos nas funções executivas. O gestor médico entende e se reconhece diante desse processo identitário (de médico a gestor médico), mas apresenta inseguranças em se reconhecer plenamente na função de gestão, como ocorre com os executivos convencionais, pois o circuito identitário se dá por meio do seu reconhecimento como médico. O empoderamento executivo linear em outras áreas, como a administração, não ocorre da mesma forma com os gestores médicos, que encaram o aceite à posição como reconhecimento e gratidão (presença de valores pessoais) e não como opção ou escolha de carreira. Desse modo, as contribuições destacadas nessa pesquisa abrangeram a academia, o meio empresarial e os próprios gestores médicos. / In the hospital organizations, the division between areas purposes (business) and middle areas (administrative), affects the management between two bodies, managers and administrative specialists managers. Historically, physicians have been occupying executive positions in these institutions, however, be a manager usually not a desire or motivation for physicians, who find their recognition in the medical specialty chosen. In contrast, hospitals, at the same time, have the challenge of forming constitute identity and develop leaders (technical people) in the pursuit of value creation. Therefore, this study sought to identify and analyze what elements are necessary for the preparation of medical and hospital organizations in situations where the former are assigned to executive functions. To that end, the research is exploratory, with the strategy fieldwork. Semi-structured qualitative interviews were conducted with 21 medical managers working in hospitals connected to ANAHP - National Association of Private Hospitals. These institutions of private health cover four Brazilian states: RS, SP, MG and DF. All interviews were audio-recorded, transcribed into text and categorized, and organized and analyzed using the qualitative research software NVivo ® 10. For discussion and interpretation of research data, we used content analysis, encompassing discursive textual analysis. The results were organized into four units of analysis: integrating medical officer in the hospital culture, understanding of the empowerment of physicians in executive functions process, discussion of professional identity of medical officer and signaling factors and practices that contribute to retention and performance of medical executive functions. The medical officer understands and recognizes before this identity process (from doctor to doctor manager), but has insecurities are fully recognized in the management function, as occurs with conventional executives because the circuit identity is through their recognition as doctor. Linear executive empowerment in other areas, such as administration, does not occur in the same way with the medical officers, who regard accepted the position as recognition and gratitude (presence of personal values) and not as an option or choice of career. Thus, this research highlighted the contributions spanned academia, the business community and medical managers themselves.