This study developed from a larger ongoing longitudinal
study of management accounting change in the NHS.
The main project is a case study of three NHS Trusts in the
East of England, and employs both qualitative and quantitative
research methods. It began in 2000, to investigate
the introduction of benchmarking of performance in NHS
hospitals by means of the NRCI, and a follow-up study
was carried out in 2005. Participants included accountants,
managers and clinicians in each Trust. As PbR was
also in the process of being introduced at this time, the
opportunity was taken to identify those participants who
had particular experience of this new development and
who were prepared to participate in further interviews.
Semi-structured interviews were held with this subset of
thirteen of the original thirty five participants, representing
all professional groups studied earlier. A semi-structured
interview schedule covered context and process of change
and included a common core section and an issue-specific
section for each interviewee. The interviews, conducted in
2006, were fully transcribed and subjected to content analysis.
Performance reports published by CHI and HC, as well
as Trusts’ internal performance reports were also used in
the empirical analysis. Additionally, government and regulatory
agency policy documents were reviewed.
A general inductive approach to data analysis was
adopted (Thomas, 2006), as such an approach allows
research findings to emerge from recurring or key themes
inherent in the data collected. Interview transcripts were
read several times by both researchers, and broad emergent
themes were identified from cross-comparison of
data both within and across Trusts studied. Thus similarities
and differences in views of participants from different
professional groups within a Trust and for the same professional
groups from different Trusts were identified. These
were discussed and subjected to a continuous process
of refinement by the researchers in order to consolidate
understanding of patterns and processes, commonalities
and differences, and highlight key themes and interconnections
(Miles and Huberman, 1994). By this means three
areas of evaluation were identified for organising the
empirical analysis, namely financial performance, business
focus and clinical/managerial relations. The validity of the
interpretation of interview findings was reinforced by a
process of triangulation, as these findings were compared
with the evidence obtained from Trusts’ internal documents
and published performance reports. Furthermore
the importance of contradiction as a key recurring theme
was identified, and influenced the choice of theoretical
framework to inform the empirical analysis.