The role of discipliningtranslating accounting practices in patientcentred care

• Published in: The International journal of public sector management 2010-06, Vol.23 (4), p.381-391
• Format: Article
• Language: English
• Subjects: Accounting; Health services; Knowledge transfer; Management accountability; Medical practice; Patient care; Sweden
• ISSN: 0951-3558
• DOI: 10.1108/09513551011047279

Purpose This paper aims to offer a critical pathway to understanding recent changes and improvements in organizing and managing healthcare such as the emerging patientcentred care PCC approach. Designmethodologyapproach The research is based on fieldwork performed as a mobile ethnography of translations of everyday healthcare work at a Swedish healthcare institution in which an analysis of the significance of contemporary accounting practices for disciplining action and thought was carried out. Findings Accounting is increasingly interlinked with medical practices today, with more and more people involved in translating action and thought into accountingbased terms and values at all levels of their work lives as this happens, accounting produces a way of thinking and valuing that even modifies professional identities. The discipline of medical knowledge is played out differently as accountingbased valuation measures become internalised into the performance of medical professionals and as additionally their images of themselves and their patients change. Patientcentred care is thereby seen not as a means of generating a pure or positive value for patients, expressed in the form of greater efficiencies and nationwide performance indicators. The loosely coupled forms of patientcentred care are about how nurses, having translated accounting practices into their work and selves, use them as a means of managing the constraints and cracks in the PCC approaches. Originalityvalue Accounting allows the dynamics of the PCC approach to be understood and acted on in new ways. Accounting as a discipline involves both accounting professionals and medical professionals who circulate accounting numbers and values. Accounting, thus, is an activity that takes place inside and outside the self.