The control gap : the role of budgets, accounting information and (non-) decisions in hospital settings

This paper investigates the link between budgets, accounting information and the decisionmaking processes at both strategic and operational levels in a large Norwegian hospital, as this hospital now is facing the New Public Management reforms which are introduced in Norway. The study has examined the use of budget and accounting information in the management control process. The empirical data are based on interviews with key actors in the decision-making process at all management levels in the hospital. The study found that budgets were not perceived by clinicians as important decision tools at the clinical levels in the hospital. The professionals felt a strong moral obligation to patients. This loose coupling between budget information and clinical action identified an inconsistency in the norms and values between the clinical and the managerial world of the hospital. In this two-worlds of responsibilities the function of the clinical managers at the department levels was found to be of vital importance as mediators between top level managers and the individual clinicians in the department and specialties. Informal “coffee-room talks” indicated that dialogues were important means of control, which could compensate for the lack of more formal and cybernetic control systems. Such frequent and informal communication may also serve a buffering function because it offers meeting points for negotiation and adjustments to initial budgets during the year. These coordination mechanisms take the mode of network based organising which can be favorable in managing organisational interdependencies