Strategizing in English hospitals: accounting, practical coping and strategic intent

Abstract

Purpose The purpose of this paper is to investigate the intricate ways in which accounting is implicated in the unfolding of strategizing in a pluralistic setting. The authors treat strategizing as a practical coping mechanism which begins in response to a problem and unfolds over time into an episode. This approach enables the authors to explore strategizing pathways and the ways they can mobilise accounting to advance from practical coping to explicit strategic intent. Design/methodology/approach The authors conducted semi-structured interviews with Clinical Directors, Business Managers and Finance personnel at three NHS hospitals. Documents were also collected, such as business cases and financial reports. The authors employed theories on strategizing agency, episodes and practical coping to select examples of strategizing and indicate how strategizing is constructed and performed. The authors present the results of this qualitative analysis in three strategizing narratives. Findings The analysis highlights how Clinical Directors’ strategizing with accounting, in response to their financial problems, can take on contesting, conforming and circumventing modes. As the strategizing pathway unfolds, accounting acts as an obligatory passage point through which Clinical Directors pursue their strategic intent. Along each pathway the authors identify, first, where practical coping takes on a clear strategic intent and, second, whether this emergent strategy proves efficacious. Originality/value The authors contribute to the nascent body of accounting and strategizing studies through seeing strategizing with accounting, not as the formulation of explicit organisational strategy as “done” in board rooms and strategy meetings, but as an impromptu response to a critical financial problem within a localised organisational setting. In response to a problem, actors may realise their immanent strategizing through their engagement with accounting practices.

'Strategy-as-practice' by hospital personnel in hospitals: a scoping review protocol

“…A recent empirical study examined the practice of strategy for a group not widely researched in the literature; medical managers in directorate roles (Begkos et al, 2019). The research focused on the strategic planning approach taken in four English NHS hospitals.…”

“…Finally, engagement and training for medical managers in strategic planning endeavours would be advisable for policymakers due to the significant role medical managers play in healthcare strategic management. Begkos et al (2019) suggested further research in comparative cross-country analysis and further contextual research in this area. Although the primary focus of the research was on medical directors which gives valuable insight into hospital strategizing for this group, it would be beneficial to consider all individuals within a hospital environment and examine who, how and what each subgroup may contribute to strategy in this arena.…”

“…Although the primary focus of the research was on medical directors which gives valuable insight into hospital strategizing for this group, it would be beneficial to consider all individuals within a hospital environment and examine who, how and what each subgroup may contribute to strategy in this arena. Begkos et al (2019) used the 'strategy-as-practice' perspective as a framework for the research. Johnson et al (2007) as a concern with what people do about strategy and how the organisational and institutional context influences this.…”

Hybridization as practice: clinical engagement with performance metrics and accounting technologies in the English NHS

“…They are knowledge experts with a varying level of competence and understanding of accounting and business processes, due to their limited management training (O'Riordan and McDermott, 2012). Yet, medical managers often engage with accounting to serve their diverse purposes via contesting, circumventing or conforming to accounting functions (Begkos et al , 2019, 2020) and extract financial value that benefits their business unit (Llewellyn et al , 2020). In addition, medical managers interact with various professional spaces in dynamic and unclear relationships characterized by great indecision and equivocality (Denis et al , 2001, 2011).…”

Strategising management accounting: liberal origins and neoliberal trends

“…Certain studies have nevertheless considered strategy as their analytical focus. For example, some explored how accounting actors become involved with and use accounting devices in strategy-making (Roslender, 1995; Roslender and Hart, 2003; Whittle and Mueller, 2010), how the use of accounting in strategy-making can be seen as an everyday practice in response to environmental dynamics (Begkos et al , 2019; Chia and Holt, 2006) and how strategising takes place as a practical coping mechanism (Begkos et al , 2019). However, these studies paid little attention to how strategising can be situated within the evolutionary dynamics of neoliberal capitalism.…”