Managing cost accounting implementation through discourse: A single case study of PEC model implementation in Region Halland

Abstract: This paper examines accounting and organizational change process and its institutional background by conducting a case study of the implementation process of a simplified Time-Driven Activity-Based Costing system in a Swedish Healthcare Region. Using a framework adapted from Zbaracki (1998), separating reality and rhetoric along a process-view, the paper examines how institutional forces enter the implementation process and how the arising tensions are managed along the process. The paper finds that authoritative professional institutions, such as literature, shape the design of the costing system, the utilization of which is shaped by professional groups. In order to manage potential conflicts from professional groups, the management is found to handle their influence by translating the accounting language of the costing model into operationally understandable instructions and guidelines, maintaining the control of the process by utilizing the language of the medical professionals and emphasizing common values to create room for both professional logic and economic logic. These findings contribute to literature on healthcare accounting and implementation of costing models in complex organizations by demonstrating how the discourse related to the implementation process impacts the reality of the implemented model and its use. The findings also confirm the central role of top management commitment in leading the implementation process.