Gustaf Kastberg

Trust and Control in Network Relations: A Study of a Public Sector Setting

This study contributes to the literature by addressing the role of trust and control in public sector settings in which several organizations cooperate; its aim is to advance the understanding of trust and control in relations in which several parties are involved. The empirical study presented is a longitudinal case study of the relationships between organizational units within a municipality and a shared service center (SSC) that provides IT and administrative services. The main finding is that, compared to actors in previous studies of dyadic relationships in the private sector, actors in network relations seem to consider trust a risky option. It is less tempting to rely on a certain party when that party in turn is entangled with other parties. This situation causes a more intensive use of formal control. Another result is that increased trust between two parties might lead to more emphasis on formal control by a third party.

THE DESIGN AND USE OF MANAGEMENT ACCOUNTING SYSTEMS IN PROCESS ORIENTED HEALTH CARE – AN EXPLORATIVE STUDY

Process orientation has made its entrance in Health Care Organizations (HCOs). The purpose is to improve patients’ journeys through the health care system. One factor that potentially affects process orientation is the design and use of Management Accounting Systems (MAS). In the literature there are worries that process orientation often is not supported by a well designed and used MAS but, on the contrary, is counteracted by a MAS designed for other purposes than supporting processes. This study contributes to the existing knowledge in that it shows how the introduction of process orientation within health care is accompanied by the development of horizontally oriented MAS (HMAS) which is used in different ways and by different actors. Generally, the use of HMAS for diagnostic control is limited. The main use of HMAS is for the purpose of mastering the events and interactive control, and the main users are the persons connected to the processes. The observation in earlier research that the existence of vertically oriented MAS may be a threat to process orientation is to some extent corroborated in the paper.

Separation and reconnection episodic organizational arenas in the strategic process

Purpose – Within the strategy as practice field several studies have recently paid attention to organizational arenas like meetings, workshops and away‐days. There has, however, been a tendency to focus on what happens “inside” separated organizational arenas. The aim of the paper is to contribute to the understanding of the relationship between the separated organizational arenas and other organizational activities in the strategizing process.Design/methodology/approach – The paper is conceptual. The framework rests on Niklas Luhmanns social systems theory and draws on recent empirical studies.Findings – The main contribution of the article is the presentation of a theoretically well‐founded framework that further specifies and problematizes the relationships of separated organizational arenas. By focusing and conceptualizing the conditions for separation and reconnection, a foundation for analyzing the interconnectedness between different arenas is provided.Practical implications – The paper contribute...

The Significance of Control Models: Intentional and Unintentional Effects

Organization and control research has largely focused on the reform work and changes in the public sector. Many studies have focused on the reasons for reforms rather than on their significance. In this article, the authors deal with a control model applied in maternity health and based on remuneration for performance. At the end of the article, the authors note that formal control models are significant. Staff members have adapted to the model, but the model has also been adjusted to suit reality. This change has meant intentional effects, in the sense that the work has been adapted to suit the conditions given, but also unintentional effects in the form of attempts to outwit the system.

The role of management accounting and control in making professional organizations horizontal

Purpose - – In the last decade, greater attention has been paid to the role of management accounting and control (MAC) in making professional organizations more horizontal. The authors argue that earlier research has not shown how the interrelatedness between professional identities and MAC influences attempts to make organizations more horizontal. In this paper the authors respond to the call for more research on the relationship between horizontalization and accounting and control. The purpose of this paper is to contribute to the emerging literature on the relationship between accountability arrangements and professional identities. Design/methodology/approach - – Theoretically the authors have an actor-network theory (ANT) approach. Empirically, the authors followed two episodes where actors at top management levels in two Swedish health care organizations introduced horizontalization. Findings - – The two episodes support the view that the role of MAC when making professional organizations more horizontal is limited. Professionals dominate what happens at the operational level and they do not act on MAC rules and performance targets in opposition of their professional identity. However, in alliance with other interessement devices MAC may have a role in creating overflows, that is, pointing out imperfections in the existing frame. The authors noticed no signs that professionals developed hybrid identities as in previous research. Originality/value - – The authors apply ANT to move beyond the commonly used contingency and new institutional sociology perspectives.

Lean and process-orienting health care – linking and disentangling activities

Purpose One of the latest trends within public administration and healthcare organizations (HCOs) is process orientation, often in the shape of Lean management. The purpose of this study is to expand our understanding of process orientation of HCOs and the more specific aim is to investigate what measures are taken to re-frame the HCOs to include the process dimension. Design/methodology/approach This empirical study is based on 67 interviews and 20 meeting observations. Findings The main observation in this study is that introducing process-oriented management solutions is about disconnecting and cutting-off existing links. The authors see how attempts are made to cut-off links to the logic of functional specialization, the autonomy of the professional worker, equal treatment of patients and other objectives. Originality/value This study adds to and expands previous studies that have problematized the use of Lean-inspired ways of organizing in the public sector.

Transforming Social Sector Auditing – They Audited More, But Scrutinized Less

The legitimacy of audit technologies is inevitably linked to a knowledge base. Even though it has been pointed out that the agreements on how to measure and verify certain operations are only temporal, empirical studies on change in audit are rare. This paper reports a detailed empirical study of change in performance audit within social services in Sweden. The paper complements previous research since this paper is not about making new things auditable but about challenging existing technologies within a field. We observe how the new ‘sharp’ control‐based model – realized through measures of prioritizing, focusing and standardizing – was related to new demands on ‘facts’ about the audit object. The effect was that many things in this new situation became unauditable; they audited more, but actually scrutinized less. The paper also contributes to existing literature on the role of ‘sharp’ control‐based audit in the social sector. With a ‘soft’ and ‘fuzzy’ object, as is often the case in many parts of the public sector, it is difficult to produce hard, convincing evidence that holds true in different settings.

Explaining process orientation failure and success in health care – three case studies

PURPOSE In order to improve cooperation and collaboration between units, clinics and departments, many health care organizations (HCOs) have introduced process orientation. Several studies indicate problems in realizing these ambitions. The purpose of this paper is to explain and understand the success and failure of process orientation in HCOs. DESIGN/METHODOLOGY/APPROACH The authors conducted three case studies and applied Actor-Network Theory as an analytic lens. FINDINGS The realization of process orientation is hindered by neglect or resistance from physicians, who find the process targets to be of low medical priority. However, the authors also see that medical priorities are no stable entities but are susceptible to negotiations. Over time, process organization, process mapping, process measurement activities and the acting of enroled actors may have impact on medical priorities. ORIGINALITY/VALUE Contrary to previous research, the findings indicate that New Public Management may not be the main obstacle against processes, that accounting figures may not be hard to disregard and that the role of leadership is not paramount.