Accounting and strategizing: medical managers' use of accounting information

Student thesis: Phd


Accounting information can be instrumental to agents who strategize. Pluralistic settings are conducive to strategizing. Although the dynamics between accounting systems and strategic decision-making are well studied in the private sector, little is known about the relationship between accounting and strategizing in the pluralistic setting of healthcare. Hence, this study investigates medical managers' strategizing practices with accounting information (e.g. building cases for investment and taking on new business). Medical managers require, at least, some expertise with accounting to employ it effectively in strategizing. In consequence, the study also explores variation in medical managers' technical knowledge of costs and level of engagement with accounting information. Thus, this research answers the question of how medical managers strategize with accounting information.The study draws upon accounting and strategizing literature, which interrogates actors' strategizing practices (e.g. Paroutis & Pettigrew, 2007), the artefacts and tools that they mobilise while strategizing (e.g. Jarzabkowski et al., 2013) and how accounting and strategizing helps actors contextualize strategic objectives and accounting concepts (e.g. Jørgensen & Messner, 2010). In doing so, accounting and strategizing studies shift away from viewing strategy as a black box (Chua, 2007; Johnson et al., 2003). This study focuses on Clinical and Medical Directors; clinicians who have both medical and managerial responsibilities. This hybrid profession is increasingly important for health care organizations, however, in the past, clinicians' competence and engagement with accounting information has not been widespread (Llewellyn, 2001; Kurunmäki, 2004).The research uses a mixed methods approach to gather and analyse empirical data. Interviews were held with Clinical and Medical Directors at four selected Trusts that demonstrated a high level of engagement between finance professionals and clinicians at different organizational levels and across all clinical specialties (Department of Health, 2013). Documentary analysis examined the use of accounting information in business cases for investment, annual strategy plans and specialty reports. A survey explored the financial training, engagement and use of accounting information for the whole population of Clinical and Medical Directors of all NHS Trusts in England. The study finds that medical managers strategize via controlling, contesting and competing (C-C-C) practices. Specifically, they strategize with accounting information to control activity and expenditure, contest imposed costs, and compete, against others, for resources. In doing so, they embed accounting in business cases, bubble charts and performance reports, using these as artefacts and tools, to display the practical and general understandings of accounting which inform their strategizing practices. Thus, for pluralistic settings like healthcare, the study introduces a theoretical 'C-C-C' typology to the notion of strategizing and makes an empirical contribution to how actors strategize with accounting information.
Date of Award1 Aug 2016
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKieran Walshe (Supervisor) & Susan Llewellyn (Supervisor)


  • NHS
  • practice
  • medical managers
  • strategy
  • costing
  • accounting
  • strategizing

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