#2925 - Topic 5 Reading A Hybrid Profession – The Acquisition Of Management Accounting Expertise By Medical Professionals - Accounting in the New Public Sector

Between 1990 and 1995, the set of practices and legitimated competencies that made up the domain of medical expertise in Finland was enlarged and transformed

Calculative expertise became part of the repertoire of practices that doctors could deploy

• Preparation of budgets, the calculation of costs and the setting prices

Abstract knowledge is held to provide the key to winning jurisdictional disputes and surviving the unending competitive game

“surely accounting is today far more socially important than medicine” (Abbott, 1988)

greater attention should be paid to the roles of techniques and their ability between professional groups, rather than focusing almost exclusively on abstract knowledge

The context of NPM reforms in Finland, where overt interprofessional competition between accountants and medicine professional ahs been absent

Notion of an “assemblage” (Miller and O’Leary, 1994), a temporarily stabilized set of relations formed among diverse actors, agents and practices, is proposed as a way of helping us to analyse the components that interprofessional relations are composed of and that result in hybridization rather than competition

In some contexts the tools of the management accountant can equally be acquired by other professional groups

Attempts to transform the activities of healers into numbers that would make medicine calculable began in earnest in the 1960s (Rose & Miller, 1992)

Greater accountability, better management, and a more efficient use of resources were increasingly demanded from all public service providers (Hopwood, 1984)

Wastefulness, arising from inadequate managerial and accounting systems, became the focus

In hospitals, where the institutional culture had typically been marked by the dominance of medical professional, and where the role of accountants had been limited to the secondary obligations of budgetary control (Orton and Weick, 1990), substantial change was envisaged (Lapsley, 1992)

The comprehensive administrative reorganizations that followed were not unique, but have been described as a characteristic feature of 20^th century bureaucratic life (March and Olson, 1983)

Public sector budgeting procedures have frequently been the focus of such reforms (Jonsson, 1982)

Results management initiatives is a label used to describe the Management by Objectives programmes launched in numerous public service settings in the mid 1980s

The involvement of medical professionals in the very early stages of the budget setting process was perceived to be important

• The problem is when they don't want to be involved such as in the UK

An additional factor helped secure the commitment of medical professionals

• Health professional were made responsible to both municipal representatives and to hospital management for keeping within their budgets

Hybridization thus emerged out of a number of localized experiments with delegated budgets, through which medical professionals became committed to the principles and practices of financial management

The interest already shown by Finnish clinical unit representatives is budget setting and control was matched by their willingness to take charge of generating and developing cost accounting and pricing systems

Limited financial resources, and the high proportion of expenditure regarded as fixed, were concerns of all Chief Physicians interviewed

One Chief Physician said that formal training in accounting should be made part of the syllabus of medical professionals

Eagerness of Finnish medical practitioners to develop their managerial skills had already been recognized at the institutions providing training in management and accounting