The role of disciplining/translating accounting practices in patient‐centred care

This paper aims to offer a critical pathway to understanding recent changes and improvements in organizing and managing healthcare – such as the emerging “patient‐centred care” (PCC) approach.

The research is based on fieldwork performed as a mobile ethnography of translations of everyday healthcare work at a Swedish healthcare institution in which an analysis of the significance of contemporary accounting practices for disciplining action and thought was carried out.

Accounting is increasingly interlinked with medical practices today, with more and more people involved in translating action and thought into accounting‐based terms and values at all levels of their work lives; as this happens, accounting “produces” a way of thinking and valuing that even modifies professional identities. The discipline of medical knowledge is played out differently as accounting‐based valuation measures become internalised into the performance of medical professionals and as additionally their images of themselves and their patients change. Patient‐centred care is thereby seen not as a means of generating a pure or positive value for patients, expressed in the form of greater efficiencies and nation‐wide performance indicators. The loosely coupled forms of patient‐centred care are about how nurses, having translated accounting practices into their work and selves, use them as a means of managing the constraints and “cracks” in the PCC approaches.

Accounting allows the dynamics of the PCC approach to be understood and acted on in new ways. Accounting as a discipline involves both accounting professionals and medical professionals who circulate accounting numbers and values. Accounting, thus, is an activity that takes place inside and outside the self.