Purpose-This paper aims to understand the role that accounting inscriptions play in mediating uncertainties between a central company and other supply chain actors in anticipation of a novel geopolitical risk. Design/methodology/approach-An exploratory comparative analysis is conducted on three large multinational food companies, each of which faced significant supply chain challenges arising from the threat of Brexit. Brexit refers to the United Kingdom's (UK's) decision to leave the European Union (EU), following a referendum, resulting in negotiations and substantial changes in trade relations between the UK and the EU. Findings-The findings reveal three distinct supply chain risk management pathways, shaped by the calculative cultures of the central companies and the actors they aim to engage with through mediation. When the central company prioritises mediating actions from suppliers and the government, and is sceptical of calculations, risk talk is primarily used. When mediation involves various supply chain actors, and the central company adopts a pragmatic approach to calculations, risk tools are integrated with risk talk to enable cohesive discussions. Finally, when the focus is on internal mediation between the finance and supply chain procurement functions, and the central company adopts a calculative idealist approach, familiarity with risk tools makes these tools central to the mediation process. Originality/value-The authors adopt a comparative ex-ante field study perspective to (1) contextualise central company decisions within this uncertainty setting, illustrating how calculative cultures shape adjustments in mediating instruments and (2) theorise how a broad set of accounting inscriptions, including both risk tools and risk talk, can be used and combined in stimulating inter- and intra-organisational mediation under supply chain uncertainty.

Severe economic crises, such as the COVID-19 pandemic, have illustrated that failure to plan for such inevitable but unpredictable events in budgetary processes adversely impacts the delivery of services. An expansion of planning and forecasting capabilities is required to improve budgetary processes. We aim to contribute by empirically investigating how the impact of the business cycle can be measured and used to enhance budgetary planning in a healthcare context. Specifically, we employ the time series vector autoregression technique to analyse the dynamic relationship between Gross Domestic Product and health expenditure. Our findings reveal that health expenditure is highly sensitive to GDP shocks, and that these effects persist over multiple years. By integrating the impact of the business cycle into the budgetary process, we demonstrate improved sophistication and accuracy in both annual and multi-year budgeting, as well as in long-term budget planning. In conclusion, our findings offer valuable insights into the multi-year impacts of economic shocks on budgets, thereby strengthening resilience and facilitating improved budget adaptation in anticipation of unforeseen events.

Adopting an institutional logics lens, this study examines how different professional groups interpret and respond to incompleteness during the development of an accounting construct in a U.S. teaching hospital. Using an interventionist research design, we co-developed the construct by integrating financial and clinical data to identify and reduce unwarranted cost variations. Drawing on 28 interviews conducted in winter 2018 and spring 2023, alongside field observations, our findings reveal distinct professional responses. Frontline clinicians recognized the construct's incompleteness but saw value in it as a discussion aid. Guided by a hybrid logic of professional autonomy and patient-centered care, they adopted a reflexive change response, selectively using the construct to enhance decision-making. Hospital managers, operating within a segmentation logic of performance and compliance, viewed incompleteness as a manageable limitation. Their pragmatic negotiation response balanced internal support for the construct with external reporting requirements. Clinician-managers, positioned between clinical and managerial logics, experienced tension when the construct failed to satisfy either. Reflecting a dominance logic where clinical concerns prevailed, they ultimately adopted an active resistance response. We contribute to accounting research by demonstrating how institutional logics shape the performative effects of accounting incompleteness. Although incompleteness is widely recognized as socially constructed and interpretively flexible, our study explains why professionals respond to the same incomplete construct in different ways. We show that institutional logics influence the performative capacity of accounting constructs by shaping how professionals interpret and respond to perceived incompleteness-either enabling uptake, redefining purpose, or undermining legitimacy-depending on how that incompleteness aligns with or challenges dominant logics.

Healthcare organizations are challenged to consistently deliver routine services during crises. This article examines how healthcare budgets are affected by business cycles, using a structured literature review to examine the public administration, public sector accounting and healthcare literature. The results demonstrate that budgetary techniques fail during a recession-requiring an emergency response. Complexities in forecasting accurate and credible targets, due to the difficulty of predicting the timing and magnitude of recessions, is leading to budgetary over-estimation. The authors call for more research on budgetary planning capabilities to measure the impact of the economic cycles on budgetary processes to minimize the need for forecasting. Interestingly, the authors found that European studies in this area tended to be published in accounting journals, while US studies were more likely to be published in public administration journals.

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The accounting literature has highlighted the role of budgeting practices in steering organisations through periods of crisis. This paper adds to this literature by drawing attention to the core and periphery dimensions of crisis-related budgetary performance evaluation. Our analysis focuses on a public hospital (periphery) operating under the guidance of a national board of management (core) during an economic and fiscal crisis, which triggered a sudden and substantial reduction in hospital funding and a significant increase in the demand for services. Exploring the role of budgetary practices in this multi-tiered setting, we identify a crisis response where budgetary evaluation was prioritised at both core and periphery levels. Examining the core and periphery separately, we observe an intensified evaluative approach at the core which triggers at the periphery an approach which placed boundaries around organisational activities via the centralisation of expenditure decisions. This response—which we identify as being an impromptu solution—may have been considered sub-optimal at the time but in fact enabled budget compliance and increased service provision. Our analysis highlights the importance of budgetary practices for facilitating value alignment among key stakeholders in times of crisis. In particular, the paper advances a perspective which suggests that divergence in how core and periphery management evaluate budget performance can enable more to be done with less in crisis periods. Overall, these findings have implications for the operation of budgetary practices in response to crises, especially in multi-tiered decision-making contexts.

Purpose COVID-19 has forced Big 4 firms to challenge existing management control arrangements and adapt their ways of working. Yet, we know little about how management control might be enacted in the future of the sustainable workplace. The objective of the study is to examine the patterns of management control change in the Big 4 accounting firms during the COVID-19 pandemic. Design/methodology/approach Adopting an exploratory qualitative research design, the authors draw on 42 interviews with directors and associates in the Big 4 professional services firms. Findings The findings reveal two pathways of management control change including alignment and displacement. The authors found that relatively minor adaptions to action and result controls were relied upon to respond to substantial cultural and personnel control changes. Originality/value The contributions are threefold: the authors take a temporal perspective to (1) unpack the changes to management control arrangements; (2) theorise the findings by developing a three-dimensional taxonomy of change pathways encompassing pace, scope and longevity of management control change and (3) contextualise management control arrangements in a hybrid work setting. Highlights COVID-19 has forced Big 4 firms to challenge existing management control arrangements. Literature has focused on traditional, onsite work settings and largely ignored change pathways. The authors take a temporal perspective to unpack changes to management control arrangements. Big 4 firms adapted to hybrid work with substantial changes to personnel and cultural controls. The authors theorise the findings by developing a three-dimensional taxonomy of change pathways.

This paper examines how changes in accounting practices during a crisis can affect organisational dynamics between hospital managers and clinicians. Our theoretical framework applies a multi-dimensional concept of power (Hardy, 1996) – which distinguishes power over resources, processes and meaning – to a longitudinal case study of a public university hospital during a budgetary crisis. Based on interviews with managers and clinicians, three successive time intervals with distinct power constellations are identified. Initially, we identify a pre-crisis phase where management formally controls resources, which seems to have limited effects on clinician dominance because managers lack 'processual power' and 'power of meaning'. Next, an implantation phase emerges whereby the introduction of mandated budget cuts triggers shifts in the distribution of power, such that managers acquire power by securing the collaboration of clinicians – a phenomenon which has tangible benefits in terms of enabling budget compliance and increased service provision. Finally, the third phase may be conceptualized as a fiscal pressure regimen whereby, when budgetary pressures intensify further, management's newly gained 'power of meaning' is eroded because management are now seen to pursue unrealistic demands. Drawing on research insights gleaned during each phase, our analysis contributes to extant literature in at least three ways. First, we present novel findings regarding the impact of crises-related applications of accounting practices on intra-organisational power constellations. Second, our work highlights how accounting practices help shape the understanding of crisis, which, in turn, impacts the distribution of organizational power and influences intra-organizational patterns of collaboration. Third, we find that awareness of the meaning power of accounting practices can help shape strategic action in crisis situations.

The COVID-19 pandemic has created unprecedented challenges to those responsible for the management of healthcare activities. These challenges require decision makers at all levels to possess a broad and comprehensive understanding of healthcare management tools, and especially of the interaction between formal control systems and the informal power dynamics which operate within healthcare organisations. Managing in healthcare is not only difficult because of the sector's high-stakes ethical contexts but also because the health care workforce is inherently complex and heterogeneous. It is the purpose of this book to survey the expanding literature on management control in healthcare with the aim of giving readers a better understanding of the options available to managers, decision-makers and also educated observers of this important sector. This book summarises key debates and findings in this rapidly developing and increasingly important field. It explores state-of-the-art models and approaches, highlights unexplored questions and gives an outlook on novel and developing trends. In so doing it provides a hands-on-guide for aspiring healthcare managers and practitioner and offers critical insights into the more advanced academic literature for those seeking a thorough grounding in the accounting and finance aspects of healthcare management.

The primary aim around developing and optimizing an electronic health record is to improve patient care and population health. The objective of this study is to design and evaluate an action research approach for the optimization of the design of a summary page artefact within an electronic health record for newborn healthcare. An action research approach was chosen for its participatory democratic process for developing practical knowledge and solutions. Collaborative workshops lead by an independent graphic facilitator with a 'bottom up' approach, involving self-selected motivated members from multidisciplinary healthcare teams, were designed and conducted. To evaluate this approach, insights were drawn from behavioural and design science paradigms to demonstrate that knowledge and understanding of the design problem and its solution were acquired in building the optimized summary page artefact. Information system development for healthcare requires consideration not just of what we do but how and why we do things. Our analysis demonstrates that action design research represents an agile and lean approach for successful optimization and implementation of information system development in healthcare.

Ireland experienced a major fiscal crisis from 2008 to 2013. This paper explores clinician responses to crisis-related control initiatives at one of Ireland's largest university hospitals. Using qualitative research methods within an interpretative framework, our study suggests that some clinicians responded with antipathy, whereas others attempted to engage with managerial demands. Using notions of organizational and occupational professionalism, we link the observed heterogeneity of these responses to factors such as the perceived usefulness of control information, the clinician management relationship, and the clinicians' specialism. Our analysis supports a nuanced interpretation of clinician behavior where their position along a continuum from resistance to collaboration is affected by group characteristics and beliefs as well as the way control information is collated and disseminated. These findings have implications for the implementation of control measures in various contexts.

Abstract Background Unnecessary bed rest results in a loss of mobility and an increased length of hospital stay. Despite mobilising regularly being acknowledged as an important preventative measure for deconditioning, inpatient functional decline continues to pose a significant challenge in hospital settings. Hospital-based mobility initiatives offer the potential to address issues of functional decline, improve patient outcomes and hospital length of stay. The aim of this research is to examine the impact of an early mobilisation initiative called “End PJ Paralysis”. Methods The research design comprises of three elements: (i) an examination of a period that promoted mobility to all patients on one acute unit (ii) an analysis of the reported number of falls during the study period and (iii) an exploration of perceptions and attitudes of nurses, nurse managers, and patients involved with the initiative. Results Our study demonstrates that following a 10-week promotion of the initiative from April 17th-June 26th 2018 in an acute care setting in south of Ireland, an increase of 15% of patients were mobilising and a decrease in the number of reported falls. In addition, staff participation was found to increase and self-reported patient satisfaction improved. Factors identified as influencing the impact of the initiative included patient and staff behavior, nurse management leadership, and effective communication. Conclusion The study provides evidence to suggest that early mobilisation initiatives can prevent deconditioning and improve patient outcomes. Each day a patient spends in hospital should contribute towards their recovery and discharge and mobilising patients while in hospital has a profound impact on their functional status.

This study investigates the effectiveness of a public sector financial management initiative. Specifically, the powers awarded to the Irish Financial Services Ombudsman (FSO) in 2013 to name and shame malfeasance by financial service providers (FSPs) in its annual reports. As the first country to award such powers to its public sector financial ombudsman, Ireland represents a novel setting in which to test the impact of regulatory disclosure as a way to promote accountability and transparency. Our results show that the number of complaints lodged against malfeasants dropped in the immediate aftermath of this and, following a one-year lag, so did the percentage of complaints lodged that proceeded to a full investigation and legally binding finding. Despite the failure of such strategies in some jurisdictions, the Irish experience indicates that regulatory disclosure can, in line with Neo-Durkheimian institutional theory and consistent with the accounting and accountability literature, have considerable impact where and when contextual preconditions are met. These findings have important implications for the operationalisation of regulatory disclosure as an accountability enhancing measure in other jurisdictions.

In this paper the Standard CAPM, the Labour CAPM, the Conditional CAPM and the Conditional Labour CAPM were tested on FTSE 100 return data over the period 1984–2004. When human capital is incorporated into the market portfolio the CAPM is able to explain additional cross sectional variation in FTSE 100 stock returns. More importantly, when the cross-sectional regression method is refined to incorporate information relating to the sign of the market realisation in the test period the relationship between beta and return is statistically significant.