Accounting, microfoundations, hybridization and longitudinal conflict in a Finnish health care organization

PurposeThis article analyzes the cognitive microfoundations, conflicting institutional logics and professional hybridization in a case characterized by conflict.Design/methodology/approachIn contrast to the majority of earlier studies focusing on special health care, the study was conducted in a Finnish basic health care organization. The empirical data include 36 interviews, accounting reports, budgets, newspaper articles and meeting notes collected 2013–2018.FindingsThe use of accounting techniques in this case did not offer professionals sufficient support under conditions of conflict. The authors suggest that this perceived lack of support intensified the negative emotions toward accounting techniques. These negative emotions aggregated into incompatible professional-level institutional logics, which contributed to the lack of hybridization between such logics. The authors highlight the importance of the cognitive microfoundations, that is, the individual-level interpretations and emotional responses, in the analysis of conflicting institutional logics.Practical implicationsManagerial attention needs to be directed to accounting practices perceived as frustrating or threatening, a perception that can prevent the use of accounting techniques in the creation of professional hybrids. The Finnish basic health care context involves inconsistent political decision-making, multiple tasks, three institutional logics and individual interpretations and emotions in various decision-making situations.Originality/valueThis study develops microfoundational accounting research by illustrating how individual-level cognitive microfoundations such as dissatisfaction with budgeting, aggregate into professional-level institutional logics, and in our case, prevent professional hybridization in a basic health care setting characterized by conflict and three separate institutional logics.

Bodies under Pressure: Experiencing Waiting Time in Basic Health Care Facilities (Morocco)

This article addresses access to basic health care facilities in Morocco, by emphasizing the issue of accommodation (Penchansky & Thomas, 1981). This article is based on data collected over three years spent in Rabat, Morocco, for fieldwork. The first year focused on hypertension. Research authorization was required for this research, which was obtained from the Ministry of Health. Research tools consisted of observations, in-depth interviews, and focus group discussions. I argue that waiting is not a passive experience or state. It is experienced with and through a mindful body (Scheper-Hughes & Lock, 1987), as an active and dynamic process that happens in a waiting room. The waiting room is conceptualized as a sphere of coexisting heterogeneity (Massey, 2005), allowing the concomitant presence of the body-self, social body, and the body politic, equivalent to body-inside and body-outside, respectively. By relating multiplicity and heterogeneity to time—biomedicine’s time, different from patients’ time, but also from the body’s time or somatic time (Limor Meoded, 2018)—, I argue that the space of the waiting room brings these various temporalities together, commanding new configurations and processes (Massey, 2005). The dynamic process of waiting is embodied; it can burst out in the form of tension, when the concomitant presence of distinct trajectories, bodies, and temporalities inside the waiting room, sometimes generate violence (verbal and symbolic). Allowing this heterogeneity to coexist smoothly is the challenge of hospital architecture and its analysis from a phenomenological perspective will bring rich data to explore and extend the project of an anthropogeography of emotions and perception.

Inefficiency Factors in Basic Health Care Supply in Côte d’Ivoire: A Comparative Econometric Analysis

The achievement of universal health coverage has put Primary Health Care back at the center of policy orientations, particularly by identifying factors likely to improve the organization of peripheral facilities. However, this objective depends on the econometric methods used, especially for cross-sectional data and small sample sizes. This study aims to examine the sensitivity of the most usual estimation methods (Stochastic Frontier Analysis (SFA), Data Envelopment Analysis (DEA), DEA double bootstrap, Tobit, Truncated Standard Regression) for evaluating the scores and determinants of technical inefficiency of Primary Health Care Facilities (PHCF) in Côte d’Ivoire. Estimates show average technical efficiency scores of 94.13% for the DEA versus 89.61% for the SFA and 82.24% for the DEA double bootstrap. The results also indicate a proportion of determinants of technical inefficiency, in decreasing order of importance, with the DEA double bootstrap, the SFA, truncated regression and Tobit. This technical inefficiency can be improved in policies to promote basic health care by: increasing the proportion of nurses in the medical staff, the nurse/inhabitant ratio, the adult literacy rate by region, controlling the average capacity of the PHCFs, improving their geographical accessibility and reducing the rate of extreme poverty by health region.

Quality of basic health care and social vulnerability: a spatial analysis

ABSTRACT Objective: To analyze the association between quality of basic health care and social vulnerability in municipalities of the Brazilian northeast. Method: Ecological study with spatial analysis using univariate global and local Moran’s indexes. Bivariate analyses were employed to examine the relationship between the quality of basic health care and the Social Vulnerability Index in the Northeast. The dependent variable corresponded to the final scores of certifications of teams of basic health care in the Northeast that had participated in the third cycle of the Brazilian Program for the Improvement of Access and Quality of Basic Health Care. The independent variable was the Social Vulnerability Index of the municipality. Results: The bivariate analysis has pointed out the presence of areas of low vulnerability with high quality basic health care in the municipalities in the states of Piauí, Ceará, Rio Grande do Norte, Pernambuco, and Bahia. The state of Maranhão is emphasized for its low performance in basic health care in a large number of municipalities with high vulnerability. Conclusion: The study has revealed a spatial relation between the indicators of social vulnerability and quality of basic health care in the Northeast, suggesting that limitations in access to health resources and services may be related to social and health determinants.