Hospital management accounting systems: Evolving roles, actors, and interactions

Seeking to offer an integrated understanding of Hospital Management Accounting Systems (HMAS) dynamics—through a synthesis of 196 studies on management accounting in public healthcare since 1980—we provide critical insights into HMAS roles—diagnostic, interactive, culture shaping, political, and symbolic—and their interconnections, shedding light on their (in)effectiveness in relation to relevant actors. The review highlights that different actors contribute significantly to the diverse roles of HMAS, while these roles—if functioning as mechanisms for meaningful change—in turn, impact their activities, managerial awareness, and power relationships. While being criticised for unintentionally intensifying value conflicts, HMAS changes reportedly have long-term impact on shaping organisational culture and reconciling values within broader public management transformations. It underscores the need for the longitudinal perspectives to better capture a holistic insight of the evolving roles and effectiveness of HMAS in empirical research. In this regard, the analytical framework we employed for examining the (in)effectiveness of HMAS and the underlying reasons through actors, roles, and interactions could provide a foundation for future empirical studies. Practically, this review advocates for greater involvement of medical professionals and patients in HMAS, promoting changes that balance flexibility with accountability while respecting medical professionals' autonomy through an interactive approach.