A hybrid profession—the acquisition of management accounting expertise by medical professionals

This paper argues that medical expertise in Finland was “hybridised” in the first half of the 1990s. It examines the willing adoption of management accounting techniques by medical professionals in the context of the New Public Management reforms in Finland. It documents this process of adoption, charts some of its effects for the set of practices and legitimated competencies that make up the domain of medical expertise, and seeks to understand these by reference to the position of management accounting within the Finnish pedagogic and institutional setting. As a counterpoint, it notes the contrast with the UK, where medical professionals have been seen to resist the intrusion of accounting practices into the medical domain.

[1]  David Brain Professional Powers: A Study of the Institutionalization of Formal Knowledge.By Eliot Freidson. University of Chicago Press. 241 pp. $20.00 , 1988 .

[2]  Peter Miller,et al.  The Factory as Laboratory , 1994, Science in Context.

[3]  Irvine Lapsley,et al.  Accountingization v. Legitimation: A Comparative Study of the Use of Accounting Information in Intensive Care , 2003 .

[4]  Jan-Erik Lane,et al.  New Public Management , 2021, Bangladesh Journal of Public Administration.

[5]  C. Hood The “new public management” in the 1980s: Variations on a theme , 1995 .

[6]  A. Hopwood,et al.  Accounting and the law , 2020, The UK and EMEA Corporate Counsel Handbook.

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

[8]  M. Savage,et al.  Professions in Theory and History: Rethinking the Study of Professions@@@The Formation of Professions: Knowledge, State and Strategy , 1993 .

[9]  Hugh Willmott,et al.  Modes of regulation in advanced capitalism: Locating accountancy in four countries , 1987 .

[10]  Christopher Pollitt,et al.  Managerialism and the Public Services: Cuts or Cultural Change in the 1990S? , 1993 .

[11]  S. Walker,et al.  Corporatism and structural change in the British accountancy profession, 1930–1957 , 1995 .

[12]  Sten Jönsson Budgetary behaviour in local government — A case study over 3 years , 1982 .

[13]  M. Covaleski,et al.  An Institutional Theory Perspective on the DRG Framework, Case-Mix Accounting Systems and Health-Care Organizations , 1993 .

[14]  G. Teubner Idiosyncratic production regimes: Co-evolution of economic and legal institutions in the varieties of capitalism , 2002 .

[15]  Toby Simon,et al.  Controlling Health Professionals The future of work and the organization in the NHS , 1994 .

[16]  P. Miller Management and accounting , 2003 .

[17]  E. Freidson Claims Examined. (Book Reviews: Profession of Medicine. A Study of the Sociology of Applied Knowledge) , 1970 .

[18]  M. Covaleski,et al.  MBO and goal directedness in a hospital context. , 1981, Academy of management review. Academy of Management.

[19]  Peter Armstrong,et al.  The decline of operational expertise in the knowledge-base of management accounting: An examination of some post-war trends in the qualifying requirements of the Chartered Institute of Management Accountants , 1992 .

[20]  Yvonna S. Lincoln,et al.  Organizational theory and inquiry , 1985 .

[21]  J. Guthrie,et al.  Global Warning: Debating International Developments in New Public Financial Management , 1998 .

[22]  Christopher Pollitt,et al.  Performance or Compliance?: Performance Audit and Public Management in Five Countries , 1999 .

[23]  Juha Näsi,et al.  Accounting and business economics traditions in Finland - from a practical discipline into a scientific subject and field of research , 1997 .

[24]  G. Larkin,et al.  Occupational Monopoly and Modern Medicine , 1983 .

[25]  Peter Armstrong The rise of accounting controls in British capitalist enterprises , 1987 .

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

[27]  Brian P. Bloomfield,et al.  Machines and manoeuvres: Responsibility accounting and the construction of hospital information systems , 1992 .

[28]  W. Bartlett,et al.  Quasi-markets and social policy , 1993 .

[29]  A. Abbott The System of Professions: An Essay on the Division of Expert Labor , 1988 .

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

[31]  Wolfgang Streeck,et al.  Community, market, state and associations? : the prospective contribution of interest governance to social order , 1985 .

[32]  James G. March,et al.  Organizing Political Life: What Administrative Reorganization Tells Us about Government , 1983, American Political Science Review.

[33]  S. Braye National Health Service and Community Care Act 1990 , 2002 .

[34]  Peter Orton,et al.  The New NHS: Modern and Dependable? , 1998 .

[35]  I. Haslock Working for patients. , 1989, British journal of rheumatology.

[36]  Thomas Ahrens,et al.  Styles of Accountability , 1996 .

[37]  A. Hopwood,et al.  Accounting calculation and the shifting sphere of the economic , 1992 .

[38]  R. Porter Patients and Practitioners: Lay Perceptions of Medicine in Pre-industrial Society , 2003 .

[39]  S. Harrison,et al.  Managing the National Health Service: Shifting The Frontier? , 1988 .

[40]  C. Tomkins,et al.  Issues in Public Sector Accounting , 1985 .

[41]  L. Edelman,et al.  Diversity Rhetoric and the Managerialization of Law1 , 2001, American Journal of Sociology.

[42]  K. Jarausch Higher education and social change: some comparative perspectives , 1982 .

[43]  Kari Lukka,et al.  The problem of generalizability: anecdotes and evidence in accounting research , 1995 .

[44]  K. Weick,et al.  Loosely Coupled Systems: A Reconceptualization , 1990 .

[45]  Thomas Ahrens,et al.  Accounting and Organizations: Realizing the Richness of Field Research , 1998 .

[46]  Rod Coombs,et al.  Fabricating budgets: A study of the production of management budgeting in the national health service , 1992 .

[47]  L. Fitzgerald Moving clinicians into management. A professional challenge or threat? , 1994, Journal of management in medicine.

[48]  Peter Miller,et al.  Accounting as social and institutional practice , 1996 .

[49]  I. Lapsley Reforming financial controls in the NHS — or is the NHS a ‘deviant’ organization? , 1992 .

[50]  Malcolm Anderson,et al.  The rise of the professional accountant in British management , 1997 .

[51]  I. Lapsley Market Mechanisms and the Management of Health Care , 1994 .

[52]  Ian P. Dewing,et al.  The Attitudes of NHS Clinicians and Medical Managers Towards Changes in Accounting Controls , 1997 .

[53]  Richard Ennals,et al.  Managing With Information Technology , 1993 .

[54]  J. L. Grand,et al.  The theory of quasi-markets , 1993 .

[55]  Stephen F. Jablonsky,et al.  The pattern of PPB rejection: Something about organizations, something about PPB , 1978 .

[56]  S. Barley,et al.  Occupational Communities: Culture and Control in Organizations , 1982 .

[57]  Eliot Freidson,et al.  Professional Powers: A Study of the Institutionalization of Formal Knowledge , 1986 .

[58]  Liisa Kurunmäki Professional vs financial capital in the field of health care--struggles for the redistribution , 1999 .

[59]  K. Eisenhardt Building theories from case study research , 1989, STUDI ORGANIZZATIVI.

[60]  R. Saltman Management control in a publicly planned health system: a case study from Finland. , 1987, Health policy.

[61]  Martin James Kitchener,et al.  The `Bureaucratization' of Professional Roles: The Case of Clinical Directors in UK Hospitals , 2000 .

[62]  J. Baxter,et al.  Alternative management accounting research—whence and whither , 2003 .

[63]  Ignace De Beelde,et al.  Creating a profession 'out of nothing'? The case of the Belgian auditing profession , 2002 .

[64]  Anne Loft,et al.  Towards a critical understanding of accounting: The case of cost accounting in the U.K., 1914–1925☆ , 1986 .

[65]  K. Eisenhardt Better Stories and Better Constructs: The Case for Rigor and Comparative Logic , 1991 .

[66]  I. Wickings Consultants face the figures. , 1983, Health and social service journal.

[67]  Peter Miller The margins of accounting , 1998 .

[68]  J. Berlant Profession and monopoly, A study of medicine in the United States and Great Britain , 1975, Medical History.

[69]  Peter Miller,et al.  The multiplying machine , 1997 .

[70]  H. Willmott,et al.  On the commercialization of accountancy thesis: A review essay☆ , 1997 .

[71]  A. Engel The English universities and professional education , 1982 .

[72]  S. Walker,et al.  A ring fence for the profession: advancing the closure of British accountancy 1957‐1970 , 1998 .

[73]  Eliot Freidson,et al.  Professional Dominance: The Social Structure of Medical Care , 1971 .

[74]  B. Latour Aramis, or the Love of Technology , 1993 .

[75]  Kenneth A. Merchant,et al.  Field Research in Management Accounting and Control: A Review and Evaluation , 1992 .

[76]  Resource management in the NHS , 1988 .

[77]  D. Rea Better Informed Judgements:Resource Management in the NHS , 1994 .

[78]  David Young,et al.  Good medicine is cheaper than bad , 1983 .