Gérald Naro

Costing hospital surgery services: the method matters.

Background Accurate hospital costs are required for policy-makers, hospital managers and clinicians to improve efficiency and transparency. However, different methods are used to allocate direct costs, and their agreement is poorly understood. The aim of this study was to assess the agreement between bottom-up and top-down unit costs of a large sample of surgical operations in a French tertiary centre. Methods Two thousand one hundred and thirty consecutive procedures performed between January and October 2010 were analysed. Top-down costs were based on pre-determined weights, while bottom-up costs were calculated through an activity-based costing (ABC) model. The agreement was assessed using correlation coefficients and the Bland and Altman method. Variables associated with the difference between methods were identified with bivariate and multivariate linear regressions. Results The correlation coefficient amounted to 0.73 (95%CI: 0.72; 0.76). The overall agreement between methods was poor. In a multivariate analysis, the cost difference was independently associated with age (Beta = −2.4; p = 0.02), ASA score (Beta = 76.3; p<0.001), RCI (Beta = 5.5; p<0.001), staffing level (Beta = 437.0; p<0.001) and intervention duration (Beta = −10.5; p<0.001). Conclusions The ability of the current method to provide relevant information to managers, clinicians and payers is questionable. As in other European countries, a shift towards time-driven activity-based costing should be advocated.

The role of the balanced scorecard in the formulation and control of strategic processes

Purpose – The aim of this paper is to confront the Balanced Scorecard (BSC) with Simons’ levers of control model and to discuss its role in the various phases of the strategic process. The authors examine the role of the BSC as a tool of interactive and diagnostic control by making a distinction between its design phase and its phase of use.Design/methodology/approach – An action research approach, based on two cases, was used to investigate the role of the balanced scorecard in strategic processes.Findings – The results show that the BSC generates a process of collective elucidation favouring the forming of emergent strategies and a process of control of the change favouring the collective representations on the strategy. The BSC thus seems to be a relevant tool for interactive control during its implementation stage. On the other hand, the authors’ observations also show the failure of the BSC as a system of diagnostic control and of interactive control during its using stage. Ultimately, it is shown th...

Management control facing the challenges of overall performance: A study carried out with management controllers

This paper aims to focus on the role of management control function in the strategies of corporate social responsibility adopted by companies. Since the years 1980/1990, multidimensional models appeared that give an integrated or balanced representation of performance. In parallel, facing the challenges of sustainable development (SD) and taking them into account in the management of companies, the concept of overall performance has developed. But, at the same time, research based on neo-institutional sociology suggests on the contrary the existence of a loose coupling between a management control oriented towards the search for legitimacy and the internal practices of management control.,The study took place between 2010 and 2015. In 2010, the authors conducted a primary exploratory survey of a sample of 40 management controllers. The study was continued in 2015 by a survey of 60 management accountants. The questionnaires were administered electronically. Sorting and cross-sorting, along with tests of independence based on the χ2 test, were carried out.,The results of the surveys have allowed us to observe the absence of significant links between proactive strategies displayed by companies in SD and the missions and instruments of management control. These latter would focus solely on measurement, monitoring and reporting of an exclusively economic and financial performance.,This is an exploratory study among French controllers. This study could be deepened by an international survey of a larger sample and by case studies with different managers involved in SD steering.,The study highlights the need to involve management controllers in steering SD.,While the literature in management control highlights the role of management accountants in the strategic alignment of SD, this study has shown the weakness of this role.,The article shows the weak involvement of management controllers in the implementation of SD, while the latter would want to become more involved in the steering of SD.