The role and use of accounting in the implementation of New Public Management ideas in Irish hospitals

This study examines the use of accounting information in the management of Irish hospitals. The Irish acute hospital sector is a significant consumer of public resources, absorbing almost half of the Department of Health & Children non-capital budget. This research was motivated by the absence of detailed studies on the use of accounting information in public sector management in Ireland. The need to provide a rich account of the complex relationship between organisational context and the functioning of accounting was identified. A qualitative research approach, using the case study method, was adopted. The New Public Management literature, together with the literatures on the professions and organisational trust, offered a conceptual perspective from which to examine accounting in the acute hospital sector.This research explores, analyses and explains the changes in accounting that have coincided with changes in management practices in four Irish hospitals, situated across two health board areas. It explores the prevalence of the New Public Management ideas and practices. It contends: that both contextual organisational factors and organisational trust influenced the adoption of the New Public Management ideas in these hospitals; that accounting control system development has lagged a rhetoric of demands for efficiency and effectiveness; that the accounting systems do not match the internal processes or structures of the organisations; that the need for information for management control has been overlooked; that accounting change has not followed increased calls for improved management of scarce resources; that each of the hospitals' budgetary systems have an outward appearance of rationality but fail to provide useful management information; that there is a secrecy and withholding of financial information from clinicians who are increasingly the focus for cost efficiencies; that each of the hospitals' accounting systems are tied to historical concerns for stewardship which permeated both the private and public sectors in the 1970's; and that whilst private sector accounting practices have developed to reflect new modes of managing, accounting practices in the two health boards and four hospitals have undergone little change