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Topic 2 Reading The Attitudes Of Nhs Clinicians And Medical Managers Towards Changes In Accounting Controls Notes

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The attitudes of NHS clinicians and medical managers towards changes in accounting controls - (Jones and Dewing, 1997)

The attudes of NHS clinicians and medical managers towards changes in accountng controls - (Jones and Dewing, 1997) Introducton

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Delegation of responsibility for health care to the point of delivery, envisaged by the NHS reforms (Department of Health, 1989)

Context of change Intensifying pressures for change

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Followed the 1970s oil crisis (Klein and O'Higgins, 1985) Cash limits were introduced in 1976 and continuous efforts were made by successive governments in Britain and many countries overseas, to find ways of improving efficiency and curtailing expenditure (Abel-Smith, 1984) Contractual or quasi-market forms, increasing delegation of resource decisions, more explicit and measurable standards, weakening trust in professionals, strengthening the hand of managers (Dunleavy and Hood, 1994) Externally imposed pressures Challenged culture within health care Griffiths' management inquiry (DHSS, 1983) - NHS was a corporate or clan culture based upon the dominance of doctors and their clinical freedom o Proposals:
? Appointment of general managers
? Decentralization of cost and budget systems
? Hierarchic control system (Bourn and Ezzamel, 1986) Internal markets... in the pursuit of efficiency and cost reduction o 'Competition with other hospitals where it is effective, should also constrain costs' (Department of Health, 1989) Revised organizational goals, devolved financial accountability to clinicians, threatened deepseated cultures, challenged the balance of power between clinicians and administrators Resistance to revised control philosophies, such as managerial model proposed by the Griffiths Report (1983)

Organisatonal implicatons of the reforms

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Commercial ethos potentially conflicted with the dual hierarchies Hierarchies became more closely integrated Administrators/managers were appointed Literature related to the sociology of professions suggests that such imposition of formalized rules and procedures is unnecessary, and may even cause professional-bureaucratic conflict, leading to impaied performance (Hall, 1972)

Implicatons for accountng control systems of organizatonal change

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Nelson and Machin (1976) suggested a model of control, based on breaking down goals and objectives concentration on budgetary control was too simplistic for public services such as the NHS costs and inputs cannot be related quantitatively to measures of outcome Empirical study of resource allocation in the NHS, Nahapiet (1988): "...relationship between accounting and organization is a complex web of multiple connections and mutual inflences evolving over time"

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