Evolution of the Governmental Accounting Reform implementation in Greek Public Hospitals: Testing the institutional framework

Purpose – In an attempt to promote efficiency, effectiveness and economy in health service production, the Greek government imposed in 2003 an accrual basis financial and cost accounting system in all public hospitals of the National Health System (NHS). The purpose of this study is not to investigate thoroughly the accounting reform implementation and adoption in specific organizations, but rather to obtain an overall idea of the reform adoption process in Greek public hospitals by identifying major areas of non-compliance with the mandatory legislative accounting framework and various organisational contingencies that influence the level of reform adoption within a broad institutional framework. Design/methodology/approach – Our analysis is based on the results of an empirical survey that took place during 2009. For the purposes of this survey, a compliance index is constructed and applied on a sample of 94 Greek public hospitals using a structured questionnaire and semi-structured interviews with six public hospital Financial and Accounting executives. Findings – The empirical evidence reveals that the level of accrual basis financial and especially cost accounting adoption in Greek public hospitals is realized only to a limited extent. In particular, results show that the relationship between the institutional isomorphic pressures and accounting reform implementation process is restricted by organizational capability factors (i.e., the quality of existing Information Technology systems, the education level of finance and accounting staff, the extent of reform related training, and the professional support of consultants). Research limitations/implications – Although this study takes into consideration the work of previous researchers in the health care area, it acknowledges that empirical research on the subject in the Greek environment is limited. Therefore this study should be viewed as an initial step to address this limitation. Originality/value – This study draws on the information systems change, ...