Examining the role of value congruence, professional identity, and managerial job engagement in the budgetary participation-performance link.

BACKGROUND: In health care, important phenomena of perceived incompatibility between professional and managerial values have emerged as consequences of New Public Management reforms. Although there is a growing evidence on the variation in the enactment of hybrid roles by medical managers, existing research in health care management is mostly descriptive with little emphasis on the conditions under which hybrid roles are enacted and, importantly, on the effects of this variation on performance. PURPOSE: In this article, we seek to fill this research gap by empirically examining (a) whether budgetary participation aligns professional and organizational values, (b) the impact of this alignment on employees' work-related feelings and managerial performance, and (c) the effect of professional identity on value congruence. METHODOLOGY: Data were collected by a survey conducted in an Italian hospital, and partial least square was used to test the relationships among variables. RESULTS: Overall, results show that (a) high involvement in budgeting is instrumental in facilitating medical managers' value congruence, and this, in turn, positively effects managerial job engagement; (b) the effect of budgetary participation on value congruence depends on the extent of professional identity; and (c) as a result of enhanced value congruence and managerial job engagement, employees tend to deliver superior role performance. PRACTICE IMPLICATION: Findings of this study provide some guidance for managers on how organizations can take steps to guarantee effective support to hybrid professionals.

Medical managers' managerial self-efficacy and role clarity: How do they bridge the budgetary participation-performance link?

This study explains the process ''how'' organizational accounting practices, such as budgetary participation, influence medical doctors' perceptions and beliefs associated with their hybrid role and what the consequences are on their performance. Building on social cognitive theory, we hypothesize a structural model in which managerial self-efficacy and role clarity mediate the effects of budgetary participation on performance. The data were collected by a survey conducted in an Italian hospital. The research hypotheses were tested employing a path model. The results suggest that role clarity and managerial self-efficacy fully mediate the link between budgetary participation and performance. From a managerial viewpoint results suggest that organizations that invest in budgetary participation will also affect individual beliefs about the perceived benefits of participation itself, since an information-rich internal environment allows employees to experience a clearer sense of direction through organizational goals. According to our results, organizations that seek self-directed employees should pay attention to the experience the medical managers acquire through budgetary participation. In fact, this event influences the employees' mental states-and specifically provides them with information needed to perform in the role and enhance their judgment of their own capabilities to organize and execute the required course of actions-which take on internal psychological motivation to reach performance levels.

Budgetary participation and performance: The mediating effects of medical managers' job engagement and self-efficacy.

Professional hybrids in healthcare have attracted a great deal of policy, managerial, and research interest. However, the current literature offers little guidance on (i) how hybrid roles can be supported by the hospital organization they work for as well as (ii) the cognitive and behavioral driving forces underpinning medical managers' managerial work that determine how they inhabit their roles and consequently meet the standards of performance that contribute to organizational effectiveness. Building on engagement theory and social cognitive theory and using data collected from clinical managers working in a large Italian public hospital, the current study focuses on the mediating role of psychological variables associated with the managerial role of medical managers, namely managerial job engagement and managerial self-efficacy, in the budgetary participation-job performance link. The results suggest that the information gained by participating in budgeting impact medical managers' thoughts and feelings about their managerial role and these, in turn, motivate different aspects of their performance. The findings are discussed in relation to theory and their managerial and policy implications.

Exploring the link between clinical managers involvement in budgeting and performance: Insights from the Italian public health care sector.

BACKGROUND: The public health care sector has had an increase in initiatives, mostly inspired by New Public Management principles, aimed at assigning financial accountability to clinical managers. However, clinical managers might experience a scarce alignment between professional values and organizational requirements, which is a potentially important phenomena that may result in negative consequences on clinical managers' job performance. PURPOSES: Building on Psychological Ownership Theory and adopting a psychology-based management accounting research approach, we focus on the managerial (nonmedical) role the clinical manager fulfills and explore the budgetary participation-performance link via the indirect effects of job-based psychological ownership, role clarity, and clinical managers' affective commitment toward managerial roles. METHODOLOGY/APPROACH: The data were collected by a survey conducted in an Italian hospital. The research hypotheses were tested employing a path model. FINDINGS: Our study revealed new insights that shed some light on underexplored processes through which mental states mediate the participation-performance link. Among these latter, the findings demonstrate that (a) budgetary participation has a direct effect on job-based psychological ownership; (b) role clarity mediates participation- and job-based psychological ownership link; (c) role clarity and job-based psychological ownership partially mediate the participation-commitment link; and (d) job-based psychological ownership, role clarity, and commitment fully mediate the participation-performance link. PRACTICE IMPLICATIONS: From a managerial viewpoint, an understanding of how clinical managers' feelings of ownership toward managerial roles could be enhanced is imperative in health care because ownership accounts for important attitudinal and organizational consequences. Results suggest that health care organizations that invest in budgetary participation will directly and indirectly affect clinical managers' psychological ownership, and this, along with role clarity, motivates clinical managers' managerial work attitudes and performance.

Budget goal commitment, clinical managers' use of budget information and performance.

Despite the importance placed on accounting as a means to influence performance in public healthcare, there is still a lot to be learned about the role of management accounting in clinical managers' work behavior and their link with organizational performance. The article aims at analyzing the motivational role of budgetary participation and the intervening role of individuals' mental states and behaviors in influencing the relationship between budgetary participation and performance. According to the goal-setting theory, SEM technique was used to test the relationships among variables. The data were collected by a survey conducted in an Italian hospital. The results show that: (i) budgetary participation does not directly influence the use of budget information, but the latter is encouraged by the level of budget goal commitment which, as a result, is influenced by the positive motivational consequences of participative budgeting; (ii) budget goal commitment does not directly influence performance, but the relationship is mediated by the use of budget information. This study contributes to health policy and management accounting literature and has significant policy implications. Mainly, the findings prove that the introduction of business-like techniques in the healthcare sector can improve performance if attitudinal and behavioral variables are adequately stimulated.

Management accounting use and financial performance in public health-care organisations: evidence from the Italian National Health Service.

Reforms of the public health-care sector have emphasised the role of management accounting (MA). However, there is little systematic evidence on its use and benefits. To fill this gap, we propose a contingency-based model which addresses three related issues, that is, whether: (i) MA use is influenced by contextual variables and MA design; (ii) top-management satisfaction with MA mediates the relationship between MA design and MA use; and (iii) financial performance is influenced by MA use. A questionnaire was mailed out to all Italian public health-care organisations. Structural equation modelling was performed to validate the research hypotheses. The response rate was 49%. Our findings suggest that: (i) cost-containment strategies encourage more sophisticated MA designs; (ii) MA use is directly and indirectly influenced by contingency, organisational, and behavioural variables; (iii) a weakly significant positive relationship exists between MA use and financial performance. These findings are relevant from the viewpoint of both top managers and policymakers. The former must make sure that MA is not only technically advanced, but also properly understood and appreciated by users. The latter need to be aware that MA may improve performance in ways and along dimensions that may not fully translate into better financial results.

International perspectives on backsourcing in health: is it just a merry-go-round?

BACKGROUND: Outsourcing in health was increasingly used in the 1990s as managerialism was adopted across the Italian and Australian public sectors. Many reasons have been given for outsourcing, such as focusing on core competencies, reducing costs and improving efficiency, reducing risk, and improving the management of labor, to name a few. Notwithstanding this, some health organizations have moved to backsourcing. PURPOSES OF THE STUDY: This research aimed to contribute to the debate and literature on managerial practices in health care by analyzing the extent of backsourcing in public health in Italy and Australia, the reasons, and expected benefits and criticalities. METHODOLOGY: To achieve the research objectives, a questionnaire was developed, and after a pilot test, it was mailed out to all Italian and Australian public providers. The questionnaire had 10 questions. Most of the responses were indicated on a 5-point Likert-type scale. Descriptive analysis was performed, such as obtaining mean and standard deviation. FINDINGS: The total response rate was 46% in Italy and 29% in Australia. Results showed that nearly 15% of the Italian and 30% of the Australian health care providers had backsourced. In both countries, a lack of complete satisfaction with outsourcing was reported. When backsourcing did occur in Italy, it was due to more freedom becoming available in hiring personnel, whereas in Australia, it was due to quality issues with outsourcing. IMPLICATIONS: Outsourcing can be considered to be an important tool that health care management may use to reach their objectives, but often, similar objectives are in place for backsourcing. This managerial learning-by-doing process seemed to emerge based on past results rather than a clear understanding of the environment and critical evaluation of criticalities prior to the event.

Outsourcing in the Italian National Health Service: findings from a national survey.

Over the last decade, outsourcing has become one of the major issues in health care. Two major concerns are related to public health care outsourcing practice. The first one involves the suitability of the outsourcing strategy in the public sector, principally with reference to the outsourcing of essential clinical services. The second one relates to the actual benefits of the outsourcing practice in health care, in terms of cost reduction and increasing efficiency. This paper aims to contribute to the debate and literature on outsourcing through a national survey carried out in the Italian National Health Service. In order to achieve the research objective, a questionnaire was developed and, after a pilot test, it was mailed to all Italian public providers. The total response rate was around 42%. Results showed that outsourcing is a widespread phenomenon within health care, especially in the ancillary services area. Moreover, results showed many criticalities of the outsourcing practice in the Italian health-care sector. On the one hand, criticalities concerned the reasons for outsourcing, the characteristics of the outsourced services and the management of the relationship with the vendor. With reference to essential clinical service, outsourcing, as currently managed by health-care providers, may potentially weaken their ability to reach its own objectives. On the other hand, criticalities related to respondent-perceived benefits. Despite the overall positive outsourcing experience expressed in the survey, the results on perceived benefits showed that the effects of outsourcing did not always align to managers' expectations, especially in the cost containment and efficiency area.

The relationship between quality management systems and organizational performance in the Italian National Health Service.

This study aims to define the underlying factors of the quality management systems that are the best predictors of public health-care providers' organizational performance and to assess the impact of those underlying factors on performance. To reach the research objectives, a national survey involving all the Italian public health-care providers (352) was carried out. The total response rate was around 42%. The findings confirmed that the quality elements described in literature as "core values" could be considered critical factors of the quality management systems adopted by Italian health-care providers. Unlike similar studies and models currently employed by the quality award organizations, this study considered the variables related to the existence and role of the quality department. The results highlighted that this element was an important underlying factor of the quality management systems adopted by Italian health-care providers. As for the impact of the characteristics of the quality management systems on organizational performance, the results showed that the outcome subjective performance was positively related to quality management variables, but there was a lack of a significant statistical relationship between financial performance and quality management. This seems to be consistent with a health policy that, so far, has not stressed sufficiently the reinforcing effect of simultaneously pursuing quality and efficiency. A health policy that intends to reach both microeconomic efficiency and service quality, on the contrary, should promote and emphasize the synergies between these two objectives. Such a conclusion seems to be an underpinning assumption of the recent National Health Plan (2006-2008) that, finally, mentions the relationship between quality and efficiency as a way to achieve macroeconomic stabilization.

Comparisons of American, Israeli, Italian and Mexican physicians and nurses on the total and factor scores of the Jefferson scale of attitudes toward physician-nurse collaborative relationships.

This cross-cultural study was designed to compare the attitudes of physicians and nurses toward physician-nurse collaboration in the United States, Israel, Italy and Mexico. Total participants were 2522 physicians and nurses who completed the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (15 Likert-type items, (Hojat et al., Evaluation and the Health Professions 22 (1999a) 208; Nursing Research 50 (2001) 123). They were compared on the total scores and four factors of the Jefferson Scale (shared education and team work, caring as opposed to curing, nurses, autonomy, physicians' dominance). Results showed inter- and intra-cultural similarities and differences among the study groups providing support for the social role theory (Hardy and Conway, Role Theory: Perspectives for Health Professionals, Appelton-Century-Crofts, New York, 1978) and the principle of least interest (Waller and Hill, The Family: A Dynamic Interpretation, Dryden, New York, 1951) in inter-professional relationships. Implications for promoting physician-nurse education and inter-professional collaboration are discussed.