Hierarchies, networks and management accounting in NHS hospitals

The pursuit of cost efficiency in the British National Health Service has resulted in increased emphasis on devolved financial accountability and the introduction of an internal market. With the aid of a case study, this paper examines alternative forms of governance and proposes that aspects of the internal market and functioning within acute hospital units, are suited to network‐style organisation. The implications of hierarchies and networks for the design and use of management accounting information (MAI) are identified. These are used to analyse the case evidence concerning the roles, intended and unintended, of MAI in the context of organisational change and where multiple, and sometimes conflicting, goals and priorities existed. It concludes that a network approach to the design of MAI is more consistent with the desirable culture, at operational level, in acute units. However, this will only be achieved through deliberate intervention by those who design MAI systems and senior managers, who by their attitudes towards the interpretation and response to MAI, shape overall organisational culture.