Implementing management accounting reforms in the public sector: the difficult journey from intentions to effects

Abstract

The aim of this paper is to gain more insight into the link between management accounting reforms and organizational learning and change in the hospital sector. In particular, the focus is put on the processes of defining and interpreting accounting information in this complex setting of public sector management. In 1997 the Norwegian government made a radical change in the hospitals' payment system. The hospitals' adjustments to these different systems of budget constraints are analysed by data from the county of Nordland and a case study in a university hospital clinic. The studies show that the hospitals adjusted to the frame budget system from 1991–7 by systematically creating budget deficits, which are identified as budget drivers during this period. The case study shows that the leaders at the clinical level made a different conceptualization of the new funding model than that of the government. Owing to these diverse conceptualizations and concrete experiences at different institutional levels, more ambiguity will occur in controlling hospital activity and cost under the new per-case funding system.