Management control system change and the impact of the economic crisis in Italian healthcare organization

In the last twenty years MCS change has represented a highly debated topic both from an academic and practioner point of view (Scapens 1994; Burns and Scapens 2000; Soin et al. 2002; Scapens and Jazayeri 2003; Busco et al.... [ view full abstract ]

In the last twenty years MCS change has represented a highly debated topic both from an academic and practioner point of view (Scapens 1994; Burns and Scapens 2000; Soin et al. 2002; Scapens and Jazayeri 2003; Busco et al. 2006; Scapens 2006; Lukka 2007; Van der Steen 2007). Four main streams of literature have analyzed this topic in recent years (Dossi et al. 2012). Contingency studies (Shields and Young 1989, 1994; Anderson 1995; Foster and Swenson 1997; Gosselin 1997; Krumwiede 1998; Anderson and Young 1999; Anderson et al. 2002; Baird et al. 2004) – the first stream - argue that MCS have an adaptive nature (Maciariello and Kirby 1994), since it is possible to identify a fit between the design of effective management accounting and control systems and contextual variables, such as environmental, organisational and strategic variables (Chenhall 2003). This research aims to contribute to the development of a process theory on management control systems (MCS) change and the impact of economic crisis in Italian healthare organizations. In a broad sense, MCS can be defined as “the formal, information-based routines and procedures managers use to maintain or alter patterns in organisational activities” (Simons 1990, p. 5). As such, they include all the tools and systems that managers use to ensure that the behaviours and decisions of their employees are consistent with the objectives and strategies of the organisation. Change refers to “an empirical observation of difference in form, quality of state over time in an organisational entity” (Van de Ven and Poole 2002, p. 512), where an organisational entity can be an individual's job, a work group, a strategy for the organisation, a product or service, or the overall MCS. The central research question is: how can healthcare organizations implement MCS change processes if they are conditioned by the institutions they wish to change? More specifically: (i) how do MCS in healthcare organizations interact with external dynamics? (ii) how do MCS in healthcare organizations interact with intra-organisational dynamics? In order to answer our research question, we use a survey. The survey is addressed to all public healthcare organizations operating in Italy at the 30/06/2016. We do expect that MCS in Italian healthcare organizations were modified as a reaction to the institutional and economic crisis, thus adopting new tools, able to connect core processes and activities; developing the ability to manage capacity resources; measuring activities and outcome; evaluating the economic sustainability of the organizations as a whole.
We do expect that, even assuming the same objective (economic sustainability), public healthcare organization may adopt different tools and act on a variety of cost and revenues drivers in order to design effective MCS