Pengarna eller livet? : Sjukvårdande professioner och yrkesgrupper i mötet med en ny ekonomistyrning

Sammanfattning: The past decades have witnessed a radical transformation of the public sector in most of the Western world. Traditional methods of organising have gradually given way to new ideas of governance, inspired by and modelled on the private sector. This thesis focuses on the management accounting changes that have taken place in the Swedish health care sector. It addresses the questions of how different occupational groups have reacted to these changes and what impact they have had on the Swedish nurses' desire to strengthen their position as a profession. Three empirical studies were conducted to answer these questions. The first study focused on an incentive system at a thoracic clinic; the second on nurses in profit centres at a hospital; and the third was based on an analysis of the debate in the Swedish nurses' trade union journal concerning the introduction of purchaser-provider models in the Swedish health care sector. Two different theoretical perspectives on accounting were used to analyse the changes. The first perspective is institutional, viewing accounting as part of rationalised reform. In the second theoretical perspective employed, accounting is regarded as an important aspect of social and institutional practice.The studies showed that the impact of management accounting models on health care practice varied. The incentive system appeared to have no effect on the practices of the occupational groups at the thoracic clinic, whereas the profit-centre system at the hospital had several consequences for the nurses working there. The studies also showed that the new management accounting models both helped and hindered nurses' aspirations to strengthen their position as a profession. While nursing care suffered, formal responsibility for profit helped to reinforce the head nurses' status on the wards and quality assurance programmes made the nurses' work more visible.