Management control in Spanish public hospitals: healthcare accreditation
Vega Pérez, Miguel
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This study examines the operation of a mandatory healthcare accreditation system to achieve a better understanding of how an externally imposed system operates as a management control tool. Adopting a qualitative research approach, this study investigates the role and features of the acute care hospital accreditation system in two public hospitals in the Spanish region of Catalonia using the case study method. Data collection over a two year period consisted of in-depth interviews, observations and access to hospital documentation. The ‘enabling & coercive’ formalisation (Adler and Borys, 1996) framework is used to analyse and interpret the findings. Overall, the study contributes to evolving our understanding of enabling/coercive features of formalisation of externally mandated control systems in the public sector context. The study reveals how the accreditation system has turned into a ‘hybrid’ model (Greenfield et al., 2016) that combines aspects of quality assurance and continuous quality improvement. Findings indicate the coexistence of coercive and enabling features of formalisation showing that both types of formalisation are not mutually exclusive. While managers perceive particular aspects of the system as coercive such as the limited autonomy to deviate from rules, they also emphasise its enabling features such as improved understanding of hospital processes due to enhanced transparency and greater teamwork. Certain features of formalisation (i.e., repair and flexibility) were found to have less relevance than in the context of an internal system and were viewed in a more neutral manner. Findings point to a close relationship between enabling formalisation and positive attitudes and between coercive formalisation and negative attitudes. However, there was some evidence of differences emphasising the importance of distinguishing between managerial intentions (enabling/coercive formalisation) and employees’ perceptions (positive, negative, and neutral attitudes) of controls (Tessier and Otley, 2012). In addition, the study illustrates that the coexistence of enabling/coercive features in the design and use of the accreditation system results in a combination of positive and negative attitudes of individuals consistent with an ambivalent orientation towards control systems (Ashforth et al., 2014).
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