Link between a Total Quality Management Initiative and the Accounting and Control System in Healthcare Setting. Abstract and Executive Summary of Dissertation

摘要

The purpose of the study is to investigate the relationship between a Total Quality Management (TQM) initiative in a health care setting and the role of the organizations accounting and control (A&C) system in facilitating or constraining the initiative. A goal of the research is to provide managers with insights about the role played by the A&C system during organizational change. The evolution in management accounting and operations management research has led to two major upheavals. First, new tools like activity-based costing (ABC) and tow-tiered cost allocation schemes have enabled managers to cost out processes. Second, TQM has helped managers to identify and streamline processes that cut across traditional departmental boundaries. A gap exists in the literature regarding the flow of information to managers that can link the two. This calls into question the applicability of the literature to meet the demands of emerging organizational forms. The literature does not adequately address the issues of timing and causality in the transition from determining organizational structure to fitting the appropriate A&C system. If a causal model exists, does the A&C system piece need to be the last task or should attention be paid to it in tandem with strategic changes. It is the last question that spans the literautre of the related disciplines. To address it, the authors studied the change process demanded by a TQM initiative in two hospitals. The choice of TQM as a strategy is recent in health care but has caught on quickly. The intense effort to reduce costs has acted as a catalyst for the implementation of TQM -like programs in many hsopitals. As programs like TQM bring structural changes to an organization, understanding the role of the A&C system of organizations undergoing such change is logical and necessary. The aim of the research is to assist managers in anwering such question as: When in the TQM change process does a change in the A&C system need to take place. Are there circumstances under which failure to change the system could pose a barrier to the successful implementation of the change process.