An examination of the influential contingencies on the role of management accounting. The case of an NHS Community Trust

Alyamoor, A.H.Y., 2019. An examination of the influential contingencies on the role of management accounting. The case of an NHS Community Trust. PhD, Nottingham Trent University.

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The study seeks to provide a deep and holistic understanding of management accounting's (MA) role in supporting organisational performance in England's community health service. Its main purposes are to illustrate the effectiveness of MA in one community health trust and how this is shaped by a set of internal, external, technical and behavioural factors. Drawing on the contingency theory of MA and the related literature, a framework was developed to investigate the conditions (contingencies) of this context and its possible influence on MA's roles, and to explore why MA is practised as it is.

The chosen research method was the interpretive case study. During an intensive field study lasting four months, data was collected about one community health trust by means of interviews, observations and documentary review. The qualitative content analysis of the collected data provided insights into how the processes and outcomes of MA are embedded in both the organisational and environmental contexts, revealing that MA’s effectiveness is influenced not only by contextual and environmental factors but also by the organisation’s other (e.g. cultural and administrative) controls. The influence of the context on MA was investigated by adopting the contingency theory of MA.

As the core of the performance management system, MA in the Trust is conceptualised by both environmental and organisational factors, with the result that it is impacted by multiple contingencies which require it to meet different, sometimes conflicting, demands. This limits the role it is able to play to mainly managerial (the budgetary control system is used mainly to ensure the efficient use of departmental resources) rather than strategic or operational. In terms of its operational role, MA in the Trust is tailored to meet external rather than internal demands, leaving clinicians dissatisfied with the information provided. The results suggest that MA could play a more useful role in the Trust with the introduction of practices such as patient-level information and costing systems (PLICS), though this is dependent on contextual and behavioural factors being taken into account, for example by providing appropriate training and encouraging dialogue and collaboration between clinicians and finance managers. The findings highlight the significant role clinical directors can play in closing the gap between these two groups. They also suggest that the multiple demands of trusts are better served by adopting a more flexible budget than by abandoning the budget altogether.

In terms of MA's strategic contribution, the findings indicate that the Trust engages in strategy formulation but pays little attention to strategy execution; a range of factors, such as efficiency targets, the contract between the Trust and the commissioners, and rising demand, force managers to focus their attention on short-term performance at the expense of strategy execution. However, while MA appears to make little or no contribution to encouraging strategic behaviour (there being no link between the Trust's operations and its strategy), the findings do show that management accountants (MAs) contribute significantly to the strategic decision-making process. The findings suggest that a full application of the BSC, underpinned by a strategy map, would enhance managers' understanding of their role within the broader strategic picture.

The study adds to our knowledge of MA by developing an understanding of MA's particular meaning and significance within the context of NHS community trusts. It shows how MA is both shaped by and shapes this context and thus whether particular MA practices are more or less appropriate for an organisation. The study's main contribution is its proposal of a theoretical framework that features a set of MA contingencies that are specific to NHS community trusts. It provides empirical evidence of the roles played by MA in these trusts and how these roles are influenced by a complex network of political, social and economic conditions, some of which work in opposition to each other. These conditions appear to be the key to understanding and explaining the process and outcome of MA in the NHS community trusts.

Item Type: Thesis
Creators: Alyamoor, A.H.Y.
Date: January 2019
Rights: This work is the intellectual property of the author. (Note: if there are other owners of the IP, they must also be named here). You may copy up to 5% of this work for private study, or personal, non-commercial research. Any re-use of the information contained within this document should be fully referenced, quoting the author, title, university, degree level and pagination. Queries or requests for any other use, or if a more substantial copy is required, should be directed to the owner(s) of the Intellectual Property Rights.
Divisions: Schools > Nottingham Business School
Record created by: Linda Sullivan
Date Added: 09 Oct 2019 13:35
Last Modified: 09 Oct 2019 13:35

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