Sue Llewellyn

• The University of Manchester

Value creation happens when hospitals provide new services or clinicians deliver existing services in better or more cost efficient ways. On the other hand, those who deliver healthcare can extract financial value from the system. Cost-based prices are now potent measures of financial value for profit centres in English hospitals. Here, we focus on...

What is a dream? It’s a complex, non-obvious pattern derived from your experience. But you haven’t actually experienced it. Strange. Revealing complex, hidden patterns makes dreams odd. Dreams associate elements of different experiences to make something new: a pattern you didn’t know was there until you dreamt it. Patterns are discernible forms in...

Strategic planning (SP) is a widely-used practice within public sector organizations. However, SP does not only take place in strategy workshops and senior management levels. This paper explores how medical managers of English hospitals ‘do’ SP in their clinical directorates. The authors investigate the practices, the usage of strategy tools and th...

Purpose The purpose of this paper is to investigate the intricate ways in which accounting is implicated in the unfolding of strategizing in a pluralistic setting. The authors treat strategizing as a practical coping mechanism which begins in response to a problem and unfolds over time into an episode. This approach enables the authors to explore...

This article argues that rapid eye movement (REM) dreaming is elaborative encoding for episodic memories. Elaborative encoding in REM can, at least partially, be understood through ancient art of memory (AAOM) principles: visualization, bizarre association, organization, narration, embodiment, and location. These principles render recent memories m...

Upon publication of the original article [1], Gregory Maniatopoulos' name was incorrectly given as 'Greg Maniatopoulous'. This has now been corrected in the original article.

Background: Accelerating the implementation of new technology in healthcare is typically complex and multi-faceted. One strategy is to charge a national agency with the responsibility for facilitating implementation. This study examines the role of such an agency in the English National Health Service. In particular, it compares two different faci...

This article argues both rapid eye movement (REM) and non-rapid eye movement (NREM) sleep contribute to overnight episodic memory processes but their roles differ. Episodic memory may have evolved from memory for spatial navigation in animals and humans. Equally, mnemonic navigation in world and mental space may rely on fundamentally equivalent pro...

Dissociative consciousness (DC) and predictive coding (PC) are new psychological concepts. DC refers to symptoms that are characterized by excessive daydreaming, absent mindedness and impairments and discontinuities in perceptions of the self, identity, and the environment, as observed in many psychiatric disorders. Recent studies have linked disso...

Predictive coding (PC) is a neurocognitive concept, according to which the brain does not process the whole qualia of external information, but only residual mismatches occurring between incoming information and an individual, inner model of the world. At the time of issue initiation, I expected an essential focus on mismatch signals in the brain,...

Writing about dreaming, the poet Raymond Carver said “I feel as if I’ve crossed some kind of invisible line”. In creative people, the “line” between wake, dreaming and psychopathology may be porous, engendering a de-differentiated, super-critical, hybrid state. Evidence exists for a relationship between creativity and psychopathology but its nature...

Background Traditionally, the cost object in health care has been either a service line (e.g. orthopaedics) or a clinical intervention (e.g. hip replacement). In the mid-2000s, the Department of Health recommended that in the future the patient should be the cost object, to enable a better analysis of cost drivers in health care, resulting in patie...

The dream as prediction seems inherently improbable. The bizarre occurrences in dreams never characterize everyday life. Dreams do not come true! But assuming that bizarreness negates expectations may rest on a misunderstanding of how the predictive brain works. In evolutionary terms, the ability to rapidly predict what sensory input implies—throug...

The target article argues memory reconsolidation demonstrates how therapeutic change occurs, grounding psychotherapy in brain science. However, consolidation has become an ambiguous term, a disadvantage applying also to its derivative - reconsolidation. The concept of re-association (involving active association between memories during rapid eye mo...

This article argues both rapid eye movement (REM) and non-rapid eye movement (NREM) sleep contribute to overnight episodic memory processes but their roles differ. Episodic memory may have evolved from memory for spatial navigation in animals and humans. Equally, mnemonic navigation in world and mental space may rely on fundamentally equivalent pro...

By 2010 English health policy-makers had concluded that the main NHS commissioners [primary care trusts (PCTs)] did not sufficiently control provider costs and performance. After the 2010 general election, they decided to replace PCTs with general practitioner (GP)-controlled Clinical Commissioning Groups (CCGs). Health-care commissioners have six...

This paper explores the ways in which technological innovation becomes adopted and incorporated into healthcare practice. Drawing upon the notion of 'field of practices', we examine how adoption is subject to spatially and temporally distributed reconfigurations across a multi-level set of practices, ranging from the policy level to the micro-level...

Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises...

I argued that rapid eye movement (REM) dreaming is elaborative emotional encoding for episodic memories, sharing many features with the ancient art of memory (AAOM). In this framework, during non–rapid eye movement (NREM), dream scenes enable junctions between episodic networks in the cortex and are retained by the hippocampus as indices for retrie...

Background The direction of health service policy in England is for more diversification in the design, commissioning and provision of health care services. The case study which is the subject of this paper was selected specifically because of the partnering with a private sector organisation to manage whole system redesign of primary care and to s...

This paper examines the dynamics and complexity of innovation adoption processes in the context of a rapidly changing healthcare policy landscape. Drawing upon the inherently socially negotiated character of meaning, this paper illustrates the ambivalent nature of technological innovation by examining the complex ongoing interplay of heterogeneous...

Evidence is accumulating that schizophrenia and bipolar disorder are related conditions. This paper proposes a particular form of relatedness. If 'schizophrenia' is a mind/brain 'trapped' between waking and dreaming, in a disordered in-between state, then bipolar 'disorder' could actually be an attempt to restore order. The mind/brain is a self-pro...

This paper proposes that schizophrenia is a state of mind/brain ‘trapped’ in-between waking and dreaming. Furthermore, it suggests that both waking and dreaming are functional. An in-between state would be disordered; neither waking nor dreaming would function properly, as the mind/brain would be attempting two, ultimately incompatible, sets of tas...

The existence and nature of underlying cause-and-effect relationships is an emerging issue in studies of Balanced Scorecard (BSC) performance measurement models. Notably, Malina et al. (2007) recently extended the debate surrounding BSC cause-and-effect relationships via their examination of a BSC model used by a Fortune 500 company. Finding only l...

The market in residential care for the elderly is in a state of flux. Key factors are the increasing proportion of elderly (particularly the 85+ age group) and central governments new community care agenda. The mixed economy of public, private and voluntary residential provision will continue but community care policy changes will entail (a) the ne...

At the inception of the internal market in health care GP fundholding was seen rather as a ‘sidesho’ to the main reforms. But as the reforms have worked through, GP fundholding has emerged as pivotal to the purchaserlprovider agenda and the changes now associated with GP fundholding will be major issues in directing future health care policy initia...

Purpose – The paper aims to provide a response to commentaries in this issue by Andrew Sayer, and Robert W. Scapens and ChunLei Yang on “Case studies and differentiated realities” a paper by Sue Llewellyn published in Qualitative Research in Accounting & Management Vol. 4 No. 1, 2007. Design/methodology/approach – Discusses issues raised in the co...

Purpose – This paper aims to challenge the conventional wisdom in qualitative case study research that the findings of the case depend on the identification of common themes across the statements of multiple case informants (usually, as expressed at interview). Design/methodology/approach – This is a methodological paper that uses a published work...

Purpose This paper aims to introduce the AAAJ special issue on “Accounting as codified discourse”, explicate the idea of codification and locate the notion of a “codified discourse” within the broader tradition of discourse studies in management. Design/methodology/approach The approach is conceptual and discursive, and provides a theoretical fram...

Purpose Although the case for case studies is now well established in accounting and management research, the exact nature of their contribution is still under discussion. This paper aims to add to this debate on contribution by arguing that case studies explore not one reality but several. Design/methodology/approach This is a theoretical paper t...

Discourses on responsibilities and rights used only to make reference to governments and individuals-not companies. Business was dissociated from non-business; companies were accountable only for economic performance. Morality and ethics belonged in the 'lifeworld' not the 'systemworld'. Only democratically elected governments and expert individual...

This article aims to expand our understanding of what it is to be an agent within an organization. To do this, the views of both Archer and Giddens on the constitution of the agent are analysed. These expositions are used to differentially illuminate the specifics of an empirical case, where it is argued that a team of ten agents were crucial in ta...

The political reforms of the public sector, termed “new public management” (NPM), now have a 20-year history. This paper looks at local differences between England and Scotland over a particular dimension of NPM — performance management in health care. In the context of the dynamic reform agenda in the UK, it is expected that these “local” lessons...

Purpose – This paper aims to bring greater clarity to the debate on the merits (or demerits) of relative performance evaluation through a broad assessment of current UK National Health Service (NHS) benchmarking. It seeks to examine whether benchmarking is being used dynamically to disseminate best practice in healthcare, or whether it is primarily...

In 1998, the UK government introduced the National Reference Costing Exercise (NRCE) to benchmark hospital costs. Benchmarking is usually associated with “excellence”; the government emphasised the raising of standards in the 1997 White Paper “The New NHS: Modern, Dependable” that heralded the NRCE. This paper argues that the UK “New Labour” govern...

Management accounting, inter alia, gives information on how resources are allocated within organisations. If managers wish to change patterns of resource allocation, accounting knowledge is pivotal to any change processes. In health care organisations resources follow decisions made by clinicians, hence to have an impact on resource allocations man...

This paper develops ideas first presented at a plenary session of the 2001 APIRA Conference, University of Adelaide, South Australia. Thanks are due to participants at APIRA for their helpful comments. The author is also indebted to two anonymous referees for constructive feedback that greatly aided the development of the paper. However, any concep...

Societies achieve their purposes through organizations. But organizations may develop into instrumental entities bereft of ethical debate. Roberts (Account. Org. Soc. 16(4) (1991) 355) claims that their hierarchical accountability systems powerfully reinforce instrumentality and individualize accountability. Based on the Habermasian ‘work’ and ‘int...

The central question addressed in this paper is 'Why have organizational strategies emerged in the public sector?' Two broad answers are suggested. First, 'strategies' profile the organization through identifying aims, outputs and outcomes. Public services must, now, provide such transparency in order to secure on-going funding from government bodi...

Public sector welfare organizations are situated at the sharp end of resource allocations in society and must cope in an environment where demand frequently far exceeds supply. In consequence, the resource problem of meeting the need for social welfare is never fully resolvable and evaluations of the ways in which scarce resources are used within t...

Recent developments in performance measurement and reporting systems in the UK National Health Service (NHS) have created new challenges in costing health care services. In particular, the introduction of the “National Reference Costing Exercise” (NRCE) has substantively changed the way in which health care cost information is reported and used. Wh...

Relative performance evaluation (RPE) is a form of benchmarking that operates through ranking institutions in comparative league tables. This paper explores issues raised by the introduction of RPE to benchmark UK hospital costs (termed ‘reference’ costs for this purpose). These reference costs are aggregated into a comparative cost index—thereby c...

This paper uses the metaphor of the `two-way window' to understand the aspirations and activities of clinical directors (doctors with management responsibilities). Clinical directors work simultaneously with sets of ideas from both clinical practice and from management, therefore, their role (as `two-way windows') allows the possibility to create a...

This paper uses the metaphor of the `two-way window' to understand the aspirations and activities of clinical directors (doctors with management responsibilities). Clinical directors work simultaneously with sets of ideas from both clinical practice and from management, therefore, their role (as `two-way windows') allows the possibility to create a...

The paper explores the potentialities for accounting research on the household, individual and family. It is suggested that the home has not been construed in accounting as an arena worthy of academic study due to the preoccupation with concerns in the glamorised and professional world of the “public”. Yet, the social and behavioural implications o...

The paper explores the potentialities for accounting research on the household, individual and family. It is suggested that the home has not been construed in accounting as an arena worthy of academic study due to the preoccupation with concerns in the glamorised and professional world of the “public”. Yet, the social and behavioural implications o...

Accounting is an interface activity, an endeavour that allows objects and artefacts to attain value (in use or exchange) across the boundaries of different domains. Accounting achieves this transferability for objects; the concept of accountability does the same for people, as peoples' levels of accountability and responsibility are implicated in a...

People reason, learn and persuade in two distinct modes – through stories (narration) and by numbers (calculation). In everyday life narration is privileged over calculation. We understand our lives through narratives, narrating experiences first to ourselves – to convince others – and then to others – to persuade them. However, within the research...

Traditionally in health care and in the public sector more generally, little thought has been given to the impact of provider-oriented incentives on the delivery of services. There has been an assumption that the language of incentives belonged to the private sector and was inappropriate in the public sector. Instead, the governance of health care...

Budgets are too aggregated, they hold too high a level in the organizational hierarchy, and they are not owned by individuals; therefore they cannot track the consequences of individual actions - these are criticisms of public sector budgets as financial mechanisms of control and accountability. Pushing budgets down the line - devolving budgetary r...

“Where does it stop on costs?”—this paper offers some responses to this question on the appropriate boundaries for costing expertise. The question was posed by a contracts officer within a social services department. The context for the question was an empirical research study in which front line welfare professionals were asked to comment, first,...

Acknowledgement: The author gratefully acknowledges the financial support of ICAS for the empirical study on which this paper is based. She would like to thank Irvine Lapsley and Stephen Walker for detailed suggestions on the paper. Thanks are also due, first, to those at the EIASM Workshop on Accounting in its Social and Organizational Context, Br...

Concurs with much of Humphrey and Scapens’ opinions about promoting eclecticism in theory, but takes issues with points made about the nature of theory. Asserts that they fail to build on the “conditions of possibility” inherent in practice by their rejection of realism. Looks at the use of accounting in the public sector, and the apparent paradoxe...

This paper describes a new research method—'the real-life construct' (RLC). Real-life constructs are built up from situationally-specific elements but they open out channels for the exploration of related organizational processes. The paper delineates one particular construct which is composed of costs, quality of care information, budget constrain...

Accounting research has traditionally been concerned with how accounting enables the organization of production. In contrast, raises the issue of how accounting is implicated in the production of the organization. Organizations are embedded in wider society, but a crucial element in their formation is that they become (and remain) differentiated fr...

In an era of ever increasing emphasis on cost-effectiveness of health care, and with the introduction of the internal market, there is now an urgent need for information on the costs and quality of palliative care. This paper highlights the complexities involved in acquiring and measuring such information and discusses methods which were tried out...

Efficiency became established as a key concept in service management during the 1980s, yet its definition within the social services remains problematic. This article defines a ratio which equates inputs with costs, and outputs with measured quality of care as an efficiency indicator in residential care for the elderly. Such a conversion ratio (as...

This paper reports on a survey of the availability of palliative care in Scotland, in the context of the internal market introduced as part of the NHS reforms. It is based on a survey of both the cost and availability of such service, with a discussion of the implications of this information for purchasers of palliative care.

Ways of thinking about accounting have changed. Management accounting, in particular, has escaped from being encompassed by a set of calculative procedures. It is now accepted that accounting has organizational and social significance simultaneously reflecting and shaping both structures and ideas. Consequently there has been increasing research in...

Researchers who hope to see the case study method adopted more widely will have welcomed Scapens' paper ‘Researching management accounting practice: the role of case study methods’. While applauding its general message and agreeing that it is essential to outline a methodology which will enhance case study research, this paper questions some of the...

Pressures for radical change in the organization and financing of local government seem certain to persist through the early 1990s. Direct Service Organizations (DSOs) are part of the local authority but have to compete with private sector organizations for the delivery of services. The concept, introduced in 1980, is now being extended across othe...