Decision Logics by Nurse Leaders: A Case Study of the Use of Accounting Information in a British Columbia Health Authority

32 Pages Posted: 15 Dec 2014

See all articles by Chris Duff

Chris Duff

Royal Roads University

Kenneth Edgar D'Silva

London South Bank University - Centre for Research in Accounting

Date Written: December 14, 2014

Abstract

The role of surgical nurse leaders within the health system of British Columbia is relatively unique. For, in addition to important medical issues, they are also largely responsible for financial budgets, output targets and key performance Indicators. The research determines insights as to how management accounting and related information systems influence surgical nurse leaders’ decision logics and their interactions with surgeons and other surgical professionals.

The research employs a case-study using primarily semi-structured interviews and documentation review. Two theoretical frames are deployed for the research. The first is Institutional Theory as a possible trans-disciplinary explanation that challenges rational decision making. The second is Actor-Network Theory with the possibility that “networks” may supplement, sustain or collapse institutional forms.

Key findings point to the limited accountability of surgeons and the importance of a selective range of surgical output incentives including a “fee for service” regimen of remuneration. Where common interests are established, persuasive power, judiciously applied by nurse leaders was found to significantly influence the medical practices of surgeons.

The scope of the research was tempered by the relatively modest inputs from surgeons and surgical leaders. A more comprehensive study with greater input from surgeons would likely be more revealing and informative.

Resource pressures on B.C. Health Authorities are intense and increasing. The research informs policy makers responsible for the design of cost controls, output incentives and key performance Indicators.

Keywords: Actor Network Theory, Decision Making, Hospital Accounting, Institutional Theory, Nurse Leaders Actor Network Theory, Decision Making, Hospital Accounting, Institutional Theory, Nurse Leaders

Suggested Citation

Duff, Christian Henry and D'Silva, Kenneth Edgar, Decision Logics by Nurse Leaders: A Case Study of the Use of Accounting Information in a British Columbia Health Authority (December 14, 2014). 2015 Canadian Academic Accounting Association (CAAA) Annual Conference, Available at SSRN: https://ssrn.com/abstract=2538231 or http://dx.doi.org/10.2139/ssrn.2538231

Christian Henry Duff (Contact Author)

Royal Roads University ( email )

2005 Sooke Road
Victoria, British Columbia V9B 5Y2
Canada

Kenneth Edgar D'Silva

London South Bank University - Centre for Research in Accounting ( email )

103 Borough Road
London, SE1 0AA
United Kingdom

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