Francesca Lecci

When the Rubber Meets the Road: Isomorphism, Rhetoric, and (Mis)management of Interinstitutional Performance

In 2012 Performance measurement systems (PMSs) became compulsory in the Italian National Health Service (NHS). The objective of this article is to answer the following research question: How do health-care organizations set up their PMSs in order to make them coherent with the institutional context and the intra-organizational dynamics? The findings show how the similar behavior of the organizations may be considered a case of coercive isomorphism. This study confirmed many topics discussed in the performance measurement literature and opens a discussion of some new research questions.

Myth #5: Health Care Is Rightly Left to the Private Sector, for the Sake of Efficiency

The Henry Mintzberg’s myth #5 has been inspired by “conventional wisdom” according to which ownership of health care providers plays an important role in the efficiency in producing services. Moreover, Henry Mintzberg argues that health care is rightly controlled by the public sector, for the sake of equality (Mintzeberg 2012). Based on these two apparently contrasting arguments one can conclude that in the system where most of provision is public, there should be some trade-offs between equality and efficiency.

Hospital acquisitions, parenting styles and management accounting change: An institutional perspective:

Many healthcare scholars have applied institutional theories to the study of management accounting systems (MAS) change. However, little attention has been devoted to MAS change within groups. Kostova et al. highlight the limitations of traditional institutional frameworks in studying groups since they are characterised not only by the existence of external institutional environments but also by intra-organisational (meso-level) ones. Given this background, the research question is: how does the meso-level institutional environment affect MAS change in healthcare groups? We use a longitudinal multiple-case study design to understand the role of headquarters in shaping local MAS change. We would expect companies to adopt similar MAS. However, we argue that the relationship between external institutions and MAS change cannot be wholly understood without taking into consideration the role of headquarters. Our analysis shows how hospitals facing the same external institutional environment implement different MAS as a consequence of different parenting styles. From a scientific perspective, our article contributes to broaden traditional institutional theoretical frameworks.