Antonio Leotta

Changes in Performance Measurement and Evaluation Systems as Institutional Processes: The Case of an Italian Teaching Hospital

Purpose – In the last decades, Italian healthcare organisations have been subject to important normative changes, aimed at increasing their efficiency. As a response, performance measurement and evaluation (PME) systems have been introduced. The present study attempts to examine PME system changes as institutional processes. In studying such processes the healthcare literature acknowledges the presence of two logics: managerial and professional, as peculiar to healthcare settings, whose convergence or divergence can explain the success of any institutional process. Design/methodology/approach – We adopt Busco et al.s (2007) framework as an approach for unbundling PME system change into four relevant coordinates, namely: (1) the object (PME system), (2) the subjects (institutional forces), (3) the place and time of change (the managerial and professional logics) and (4) the how and why change happens (change as an institutional process). We conducted a longitudinal case study at a large teaching hospital in Southern Italy, directed to interpret PME system changes during the period from 1998 until 2009. Findings – Our observation distinguishes episodes of successful institutional processes, where the introduced innovations are transformed into objectivated practices, from episodes of missed institutionalisation, where new procedures were rapidly abandoned. Research and social implications – This theoretical framework can be useful for interpreting the PME system changes in different institutional contexts. Originality – The Busco et al.s framework allows us to understand PME system changes by integrating the perspectives from Neo-Institutional Sociology, representing healthcare organisational responses to external institutional pressures, and Old-Institutional Economics, conceptualising PME system changes as an institutionalisation process.

Management accounting and leadership construction in family firms

Purpose - Succession in family firms may determine the survival or the failure of the business itself. Management accounting literature has added little to this issue, mainly focusing on the process of succession and change (Songini Design/methodology/approach - Drawing on the perspective of actor-reality construction (ARC), the authors conducted a case study at a small-sized family firm producing solar shading systems. The authors examined how the construction of the successor’s leadership derives from the integration of four dimensions of reality: facts, possibilities, values and communication. Such an integration is facilitated by the introduction of a new accounting information system and cost reporting. Findings - The case evidence highlights that the construction of the new generation leadership may emerge as a consequence of the introduction of new MA practices. Moreover, the field evidence highlights that the construction of a new generation leadership is a process that integrates the four dimensions of reality. Originality/value - From the emergent perspective of ARC, the paper highlights how new MA practices play an active role in constructing the new generation leadership.

Performance measurement system innovations in hospitals as translation processes

Purpose - The purpose of this paper is to highlight how the variety of the actors involved in a performance measurement system (PMS) innovation are spread out in time and space. Healthcare contests are examined, where such an innovation is influenced by present and past systems and practices (spread out in time), and by managerial and health-professional actors (spread out in space). Design/methodology/approach - Drawing on Callon’s actor network theory, the authors describe PMS innovations as processes of translation, and distinguish between incremental and radical innovations. The theoretical arguments are used to explain the evidence drawn from a longitudinal case study carried out in an Italian public teaching hospital, referring to the period from 1998 up to 2003. Findings - The conceptual framework shows how the translation moments lead to a recognition of the different actants involved in a PMS innovation, how their interests are interrelated and mobilized. Moreover, it shows how the interaction among the actants involved in the process is related to the type of PMS innovation, i.e. radical vs incremental. The case evidence offers detailed insights into the phenomenon, testing the explanatory power of the framework, and highlights how the failure of one of the translation moments can compromise the success of a PMS innovation. Originality/value - This study differs from the extant accounting literature on PMS innovations as it highlights how the introduction of a new PMS can be affected by some elements of the previous systems “package,” which are relevant for the mobilization of the actants through the new project.

I processi di cambiamento che portano alle scelte di "make and buy" e gli effetti sul controllo dei sub-fornitori. Il caso STMicroelectronics

Although make or buy decisions are still studied as choices between alternative options, hybrid organizational forms, resulting from make and buy decisions, are quite widespread. Such settings may derive from outsourcing processes which, due to various constraints, can remain uncompleted. From the perspective of a single decision-maker, a partial outsourcing may be due to organizational resistances, especially from the entities that should be outsourced. In many circumstances, however, even though these resistances seem to constrain the outsourcing choices, they can allow appropriate organizational solutions, as in the case of outsourcing control, which can take advantage from make and buy decisions. The paper examines how a partial outsourcing process impacts on the configuration of outsourcing control and its effectiveness. After a critical review of various theoretical perspectives, the actor-network view is proposed as the most appropriate approach to study the phenomenon. A single case study is then carried out to show how the viewpoints of various organizational units allow the assessment of a hybrid organization where internal units allows an effective outsourcing control.

I cambiamenti nei sistemi di misurazione e valutazione manageriale nelle aziende ospedaliere universitarie come contesti multi-stakeholder: proposizioni teoriche ed evidenze empiriche

Given the growing attention to changes in performance measurement and evaluation systems in healthcare contexts, the present study aims at improving our understanding of such processes within teaching hospitals, examining how managerial and health-professional logics contribute to these changes. In the theoretical part of the study we analyse teaching hospitals as multistakeholder contexts. Particularly, we propose a theoretical approach that represents changes as dialectical phenomena so as to explain how the interaction among influential stakeholders (representing managerial and professional logics) affects changes in performance measurement and evaluation systems. The empirical part of the paper is devoted to a case-study focused on changes in performance measurement and evaluation systems in a Sicilian teaching hospital. The empirical analysis aims at examining the observed changes in the light of the theoretical framework proposed, emphasizing the interactions among the logics that characterize the teaching hospital context.

Inter-firm coordination as an Information problem. The case of a divisionalized company

The extant literature on inter-organizational control distinguishes the main control problems as coordination problems and appropriation concerns. The present study focuses on coordination problems and is intended to understand the process leading to the hybrid nature of inter-firm coordination modes and the role of information in this process. In a theoretical part, after discussing the main critical assumptions underlying coordination studies, an integrative framework is proposed to conceptualize the coordination process and describe the role of information in this process. In Particular, the framework assumes inter-firm settings as a-centered and a-static, whence the relevance of an interpretive approach where coordination is viewed as a process characterized by dialectic interactions between coordinating actors. The empirical part of the study is aimed at verifying the explanatory power of the framework studying a case of outsourcing relations in a divisionalized company operating in the semi-conductor industry. The case provided useful data giving new insights that enrich the framework.