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

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.
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. We present the results of this qualitative analysis in three strategizing narratives.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 we identify, first, where practical coping takes on a clear strategic intent and, second, whether this emergent strategy proves efficacious.
The authors contribute to the nascent body of accounting and strategizing studies through seeing strategizing with accounting, not as the formulation of explicit organizational strategy as ‘done’ in board rooms and strategy meetings, but as an impromptu response to a critical financial problem within a localised organizational setting. In response to a problem, actors may realise their immanent strategizing through their engagement with accounting practices.