Fabricating budgets: A study of the production of management budgeting in the national health service

This paper examines the processes by which a form of responsibility accounting system emerges in an organizational context. The paper utilizes recent approaches to the understanding of how science and technology is created (Latour, Science in Action, Harvard University Press, 1987) to investigate the processes by which a management budgeting initiative in the U.K. hospital system takes hold (or not) in specific hospitals. The approach is critical of the notion that accounting systems are well-defined technologies which are designed and then implemented (or face resistance). Instead, the study shows that management budgeting is fabricated, put together in a changing and fragile manner. Emerging accounting systems are not fixed technologies with well-defined purposes which reflect patterns of responsibility but changing constructions. Management budgeting systems are initiated with loose characteristics, purposes and uses. In the process of their design and implementation, new possibilities for decision making and definitions of responsibility emerge. Through this study of accounting in action, the paper explores the processes by which accounting and budgeting systems bring economic logic into hospital management. It is also relevant to debates about the role of budgeting and accounting in health care organizations in many countries.

[1]  Thomas H. Johnson,et al.  Relevance Lost: The Rise and Fall of Management Accounting , 1987 .

[2]  P. Wilding.  Professional power and social welfare , 1982 .

[3]  A. Wildavsky,et al.  The Politics of the Budgetary Process. , 1965 .

[4]  Stuart Burchell,et al.  Accounting in its social context: Towards a history of value added in the United Kingdom , 1985 .

[5]  Mark W. Dirsmith,et al.  The use of budgetary symbols in the political arena: An historically informed field study , 1988 .

[6]  Peter Armstrong.  CHANGING MANAGEMENT CONTROL STRATEGIES: THE ROLE OF COMPETITION BETWEEN ACCOUNTANCY AND OTHER... , 1985 .

[7]  J. Coles,et al.  Review of clinical budgeting and costing experiments , 1983, British medical journal.

[8]  R. Klein.  The politics of the National Health Service , 1983 .

[9]  B. Latour.  Science in Action , 1987 .

[10]  Christopher Pollitt,et al.  THE RELUCTANT MANAGERS: CLINICIANS AND BUDGETS IN THE NHS , 1988 .

[11]  A. Hopwood,et al.  An accounting system and managerial behaviour , 1973 .

[12]  D. Bloor,et al.  Knowledge and Social Imagery , 1977 .

[13]  M. Burrage.  Nationalization and the Professional Ideal , 1973 .

[14]  Peter Miller,et al.  Accounting and the construction of the governable person , 1987 .

[15]  John H. Waterhouse,et al.  A contingency framework for management accounting systems research , 1978 .

[16]  A. Hopwood,et al.  The archeology of accounting systems , 1987 .

[17]  Tony Tinker,et al.  The social construction of management control systems , 1986 .

[18]  D. Mccloskey.  The Rhetoric of Economics , 1988 .

[19]  T. Pinch,et al.  Clinical budgeting: Experimentation in the social sciences: A drama in five acts , 1989 .

[20]  R Klein,et al.  Central accountability and local decision making: towards a new NHS. , 1985, British medical journal.

[21]  D. Otley.  The contingency theory of management accounting: Achievement and prognosis , 1980 .

[22]  T. Tinker,et al.  THE 'REAL' CULTURAL SIGNIFICANCE OF ACCOUNTS. , 1987 .

[23]  S. Hall,et al.  The hard road to renewal , 1988 .

[24]  J. Perrin.  Management of Financial Resources in the National Health Service , 1979 .

[25]  L. Doyal,et al.  The political economy of health , 1979 .

[26]  Norman B. Macintosh,et al.  A contextual model of information systems , 1981 .

[27]  B. Latour,et al.  Laboratory Life: The Social Construction of Scientific Facts , 1983 .

[28]  A. Giddens.  The Constitution of Society , 1985 .

[29]  J. Appleby,et al.  Health and efficiency. , 1993, The Health service journal.

[30]  William J. Bruns,et al.  Accounting and Management: Field Study Perspectives , 1987 .

[31]  M FISHBEIN,et al.  Health and social security. , 1948, Journal of the American Medical Association.

[32]  John H. Waterhouse,et al.  Towards a descriptive theory of management accounting , 1983 .

[33]  Robert S. Kaplan,et al.  The evolution of management accounting , 1984 .

[34]  Alfred D. Chandler,et al.  Administrative coordination, allocation and monitoring: A comparative analysis of the emergence of accounting and organization in the U.S.A. and Europe , 1979 .

[35]  Trevor Pinch,et al.  Colonizing the Mind: Dilemmas in the Application of Social Science , 1987 .

[36]  D. Cooper,et al.  Power and Management Control , 1989 .

[37]  P. Ferguson,et al.  MANAGEMENT CONTROL IN AN AREA OF THE NCB: RATIONALES OF ACCOUNTING PRACTICES IN A PUBLIC ENTERPRISE. , 1985 .

[38]  Resource management in the NHS , 1988 .