Creating an identity for a heterogeneous system in health care

Abstract

Purpose – This paper aims to discuss the implementation process for the new diagnosis-related groups (DRG) accounting system in the health-care sector, and the struggle to gain acceptance for the system. The emphasis is on the goals and the expected results of the system, and how the system finally becomes an actuality. Design/methodology/approach – The paper illustrates the framing of an accounting system, that is, how the health organization constructs the goals and the purposes of the system during its implementation. The empirical data consist of interviews, newspaper articles and notes from participatory observations. Findings – The goals and the purposes of the new system were not defined ex ante, but rather emerged as supporters of the system found a common language. This commonality enabled the linking of the interests of the hospital managers with the DRG system. At this point, the actual DRG-based systems for the product categorization and the full-cost pricing system became heterogeneous. Making the system visible through discussion entailed seeing the invisible. Seeing the invisible allowed the system to become a reality (national comparability). Visibility helped the DRG system to gain approval and become a stronger system. Research limitations/implications – This study is an illustration of a unique social process. The study’s applicability under other circumstances should be considered with caution. Originality/value – The paper illustrates how the purpose of an accounting system emerges and is constructed through the interaction between various actors.