When institutional entrepreneurship failed: The case of a responsibility centre in a Portuguese hospital
Accounting, Auditing & Accountability Journal
ISSN: 0951-3574
Article publication date: 21 May 2018
Issue publication date: 21 May 2018
Abstract
Purpose
The purpose of this paper is to demonstrate the role of power relations in initiating and blocking accounting change that involves increased “responsibilisation” and “incentivisation”, and to understand how institutional entrepreneurship is steered by power strategies.
Design/methodology/approach
An in-depth case study was carried out between 2010 and 2015 in a cardiothoracic surgery service (CSS) where a responsibility centre was introduced.
Findings
Introducing a responsibility centre within a CSS led to a change process, despite pressures for stability. The institutionalisation of change was conditioned by entrepreneurship that flowed through three circuits of power. Strategies were adapted according to changes in exogenous environmental contingencies and alterations in the actors’ relationships.
Originality/value
The contributions of the paper are several: first, it demonstrates that the existing literature discussing the implementation of responsibility centres cannot be isolated from power issues; second, it expands understanding of the power dynamics and processes of institutional entrepreneurship when implementing accounting change; third, it shows how change introduced by exogenous political economic events structured organisational circuits of power and blocked the introduction of the change initiative.
Keywords
Acknowledgements
The authors would like to thank Bob Scapens, Sue Llewellyn, Sven Modell, and participants at the EAA Congress 2016, APIRA 2016 and the ENROAC 2017 for suggestions on earlier drafts of this paper. The authors would also like to thank the Hospital Centre of Central Lisbon, especially Santa Marta Hospital and the Cardiothoracic Surgery Service for allowing the study, and to the research participants. The authors are also very grateful for the comments the authors received from the two anonymous reviewers. The first and third authors acknowledge that this work was funded by National Funds through FCT - Fundação para a Ciência e a Tecnologia under the project Ref. UID/ECO/00124/2013 and by POR Lisboa under the project LISBOA-01-0145-FEDER-007722.
Citation
Major, M., Conceição, A. and Clegg, S. (2018), "When institutional entrepreneurship failed: The case of a responsibility centre in a Portuguese hospital", Accounting, Auditing & Accountability Journal, Vol. 31 No. 4, pp. 1199-1229. https://doi.org/10.1108/AAAJ-09-2016-2700
Publisher
:Emerald Publishing Limited
Copyright © 2018, Emerald Publishing Limited