This paper aims to contribute to the literature in terms
of both theory development and furthering understanding
of management accounting in practice. It combines insights
of structuration theory and institutional theory to provide
a holistic analysis of change, given their capacity to reveal
the origins of contradiction faced by actors at the structural
level, and to highlight the role of performance management
systems in the mediation of power relations at the
action level, as they provide a focal point for conflict and
struggle through the enactment of praxis by organisational
actors.
The paper reveals how new developments in performance
management systems helped to reconstitute
understanding of legitimate organisational activity. Additionally,
it contributes to the understanding of management
accounting practice, by examining consequences of
major change in the NHS. It evaluates the effects, positive
and negative, for NHS Trusts of implementing new developments
in performance measurement and management,
and identifies important factors which facilitate or impede
change.
The study illustrates the value of structuration theory
as a sensitising device for understanding important contextual
factors which give rise to contradiction. It enables
examination of the inter-linking of structures of signification,
legitimation and domination, and how actors draw on
these sometimes to reinforce the status quo and sometimes
to effect change. The introduction of firstly star ratings
and secondly the annual health check are illustrative of an
effort to introduce anewshared language for assessing performance,
which could potentially enhance understanding
and co-operation between accountants, managers and clinicians.
Sanctioning of such change (legitimation) by all
actors was sought by combining in one performance management
system measures of both financial performance
and quality standards. New domination structures were
evident in the form of new regulatory bodies to oversee
performance and with power to allocate or withhold
resources. The most successful Trusts were rewarded with
more freedom and resources when they were granted
FT status, whereas the least successful were branded as
‘failing’, management was replaced and new leadership
imposed. These developments were legitimated in part by
the rhetoric of patient choice.