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Purpose This paper aims to explore how the introduction of new accounting information influences the understandings of cost-consciousness. Furthermore, the paper explores how managers use accounting information to shape organizational members’ understanding of changes, and how focusing on cost-consciousness influence professional culture within social services. Design/methodology/approach The paper is based on a case study, drawing on sensemaking as a theoretical lens. Top management, middle management and staff specialists at a medium-sized Danish municipality are interviewed. Findings The paper demonstrates how accounting metaphors can be effective in linking cost information and cost-consciousness to operational decisions in daily work practices. Further, the study elucidates how professionalism may be strengthened based on the use of accounting information. Research limitations/implications The study is context specific, and the role of accounting in professional work varies on the basis of the specific techniques involved. Practical implications The paper shows how managers influence how professionals interpret and use accounting information. It shows how cost-consciousness can be integrated with social work practices to improve service quality. Originality/value The paper contributes to the literature on how accounting information influences social work. To date, only a few papers have focused on how cost-consciousness can be understood in practice and how it influences professional culture. Further, the study expands the limited accounting metaphor research.
Making sense of cost-
consciousness in social work
Per Nikolaj Bukh
Aalborg University Business School, Aalborg University, Aalborg Øst, Denmark
Karina Skovvang Christensen
Department of Economics and Business Economics, Aarhus University,
Aarhus, Denmark, and
Anne Kirstine Svanholt
Aalborg University Business School, Aalborg University, Aalborg Øst, Denmark
Purpose This paper aims to explore how the introduction of new accounting information inuences the
understandings of cost-consciousness. Furthermore, the paper explores how managers use accounting
information to shape organizational membersunderstanding of changes, and how focusing on cost-
consciousness inuence professional culture withinsocial services.
Design/methodology/approach The paper is based on a case study, drawing on sensemaking as a
theoretical lens. Top management, middle management and staff specialists at a medium-sized Danish
municipality are interviewed.
Findings The paper demonstrates how accounting metaphors can be effective in linking cost information
and cost-consciousness to operational decisions in daily work practices. Further, the study elucidates how
professionalism may be strengthened based on the use of accounting information.
Research limitations/implications The study is context specic, and the role of accounting in
professional work varies on the basis of the specic techniques involved.
Practical implications The paper shows how managers inuence how professionals interpret and use
accounting information. It shows how cost-consciousness can be integrated with social work practices to
improve service quality.
Originality/value The paper contributes to the literature on how accounting information inuences
social work. To date, only a few papers have focused on how cost-consciousness can be understood in practice
and how it inuences professional culture. Further, the study expands the limited accounting metaphor
Keywords Budgeting, Sensemaking, Management accounting, Metaphors, Public sector, Social
services, Cost-consciousness
Paper type Research paper
When collecting the data, Anne Kirstine Svanholt was an industrial Ph.D. student. The project
was funded by Innovation Fund Denmark, KMD, COK and the Association of Municipality
CFOs. None of the funders had any inuence on the selection of research site, or the research
process. We wish to thank the participants from the municipality for participating in this
research project.
We are grateful for the helpful comments from two anonymous reviewers. Further, we are
especially grateful to the editor Lukas Goretzki for his advice in the revision of the paper.
Social work
Received 10 October2019
Revised 17 February2020
13 September 2020
Accepted 28 October2020
Qualitative Research in
Accounting & Management
© Emerald Publishing Limited
DOI 10.1108/QRAM-10-2019-0105
The current issue and full text archive of this journal is available on Emerald Insight at:
1. Introduction
In recent years, austerity politics (Bracci et al.,2015) has increased pressure on local
government organizations (Van der Kolk et al., 2015) and cost-conscious driven by changes
in management control systems has become important. The introduction of accounting
systems and information within social care has been described as a conict between
costing and caring(Llewellyn, 1998a). Research has focused on how accounting manifests
actions (Bracci and Llewellyn, 2012;Carlsson-Wall et al., 2016;Kraus, 2012;Schrøder,2019a,
Cost-consciousness is associated with accounting techniques and cost reductions
(Velasquez et al., 2015). Thus, it may conict with norms and values in social services, where
professionals determine the services provided to citizens based on their individual needs
(Abernethy et al., 2007;Schrøder, 2019a). Consequently, professionals often respond with
resistance because they perceive the introduction of new accounting techniques and controls
as threats to their autonomy (Buckmaster, 2018;Purcell and Chow, 2011) or because the
delegation of responsibilities fails to include front-line workers (Llewellyn, 1998b). However,
research has also shown that professionals commit to nancial targets and willingly accept
nancial responsibilities (Lehtonen, 2007;Kurunmäki et al.,2003;Kurunmäki, 2004).
Furthermore, Carlsson-Wall et al. (2016) showed that accounting talk(Ahrens, 1997;Hall,
2010;Jönsson and Solli, 1993) that uses metaphorical representation contributed to
achieving a greater nancial consciousness and more nancial appropriate behaviour
among front-line workers(Carlsson-Wall et al.,2016, p. 234).
When new forms of accounting are introduced, middle managers have a crucial role as
change agents (Bukh and Svanholt, 2020;Deschamps, 2019;Wooldridge et al.,2008) where
they actively shape organisational development trajectories(Carlsson-Wall et al.,2016,
p. 215). In particular, we study how the managers actively engage in interpreting, using and
communicating accounting information and how managers make sense of accounting and
changes when new information and practices are linked to familiar ones. Specically, the
study addresses the following three research questions:
RQ1. How does the introduction of new accounting information inuence how
managers and professionals understand cost-consciousness?
RQ2. How do managers use accounting information to frame professional
organizational membersunderstanding of the intended changes?
RQ3. What are the results of the introduction of a cost-conscious culture within social
In this paper, we focus on middle managers, when the need for improved cost-consciousness
is introduced to a Danish municipalitys social service department (i.e. Alpha). We draw on
sensemaking (Weick, 1995)asatheoretical lens(Lukka and Vinnari, 2014, p. 1309) to
address these questions and explore how managers, as change agents, use accounting
information to improve cost-consciousness. In addressing the research questions, the study
makes three contributions.
First, the study contributes to the cost-consciousness literature by demonstrating how
accounting information link cost-consciousness to daily operational decisions in practice. On
the one hand, previous research (Abernethy and Vagnoni, 2004;Shields and Young, 1994)
has examined specic factors that drive cost-consciousness. On the other hand, cost-
consciousness has been associated with organizational culture, suggesting a strong role of
management control systems in the driving of cost consciousness(Velasquez et al.,2015,
p.70). However, research on how accounting, accounting knowledge and accounting
information inuenceculture in practice to foster cost-consciousness is less clear. This study
lls this gap by showing how managersability to link cost-consciousness to daily work
using accounting information inuences organizational culture in relation to cost-
Furthermore, the study adds to the cost-consciousness literature by illustrating the
implications of cost-consciousness for operational decisions. As mentioned in
Velasquez et al.s (2015) review, cost-consciousness has been associated with a general focus
on reducing costs and using budgets with abstract cost awareness. Specic studies dene
cost-consciousness as an economic judgment of operations (Kurunmäki, 1999,p.121)or
economic efciency (Nor-Aziah and Scapens, 2007, p. 217), rather than an attempt to capture
the trade-off between costing and caringdescribed by Llewellyn (1998a;cf.Abernethy and
Vagnoni, 2004, p. 213). This study supplements extant literature by showing that cost-
consciousness is not only a matter of cost reductions but also of managing the trade-off
between cost and care in daily work.
Second, the study contributes to the literature about the role of accounting information in
public sector services organizations by showing how managers can use accounting
information and accounting metaphors (Carlsson-Wall et al.,2016) to trigger sensemaking
and drive change. Some researchers (Llewellyn, 1998b;Nyland and Pettersen, 2004) have
found that the increased use of accounting techniques and information do not change core
values and work practices, and professional work can be reconciled with accounting
techniques (Kraus, 2012). However, other researchers (Buckmaster, 2018;Chow et al.,2019;
Liljegren, 2012) have emphasized how professionals respond to resistance, especially when
accounting practices are perceived to be in conict with their clientsneeds(Carlsson-Wall
et al.,2016, p. 220). Recent research (Schrøder,2019a, 2019b) has pointed to the question of
how cost accounts and needs are introduced and connected in practice. Therefore, we add to
extant research by highlighting middle managerscritical role in the introduction of
accounting information and accounting techniques. Similar to Carlsson-Wall et al. (2016),
this study shows the effectiveness of metaphors when cost and needs are connected in daily
Third, this study contributes to the literature about how management control inuence
professions and professional values (Abbott, 1988;Chow et al.,2019;Adcroft and Willis,
2005;Evetts, 2009;Noordegraaf, 2007;Wällstedt, 2017), by indicating how accounting
information may professionalize social work. Research on professional work has primarily
focused on health care, wherein professionals are expected to have legitimate expertise that
can only be regulated by other professionals (Abbott, 1988) and where professionalism is
based on the application of scientic knowledge (Noordegraaf, 2007, p. 765). In contrast,
social work focuses on the relationship with the client (Parton, 2008) wherein complexity
creates uncertainty because of the lack of technical knowledge about the nature of problems
and their solutions (Llewellyn, 1998a). Consequently, professional control is difcult to
institutionalize. This study contributes to the extant literature by highlighting how
professionalism may be strengthened based on accounting information.
The rest of this paper is organized as follows: Section 2 briey reviews the literature on
professional social work, showing how professionalism can potentially be inuenced by
accounting information and accountingization, Section 3 introduces the analytical
framework and explains how a sensemaking perspective is used, Section 4 presents the
studys empirical setting and describes the methodology, Section 5 analyzes how changes in
accounting information trigger and enable sensemaking processes at the managerial level
and how outcomes of these processes lead to new working practices and prime
understanding and Section 6 discusses the results and concludes the paper.
Social work
2. Accounting information in social work
Research has often focused on the diffusion of management accounting techniques from the
private sector to the public sector and how this has inuenced reforms and changes. This
emphasis on management accounting techniques, including cost measures, has been
described as a process of accountingization(Power and Laughlin, 1992) where accounting
as an economic language colonizes professional cultures and where the professional practice
is threatened. This has also been the case with social work where relationships have been a
primary tool since the 1970s (Parton, 2008). However, the increased use of techniques of
computation and calculation, procedures of examination and standardization (Miller and
Rose, 1990, p. 8) challenge the professional culture and the meaning of social work.
2.1 Professional social work
Classic pure professionals (e.g. medical doctors) have traditionally been considered collegial,
self-regulating expert occupations, where professional autonomy includes legitimate
expertise that only professionals can regulate (Abbott, 1988). Further, Noordegraaf (2007)
has emphasized that professionalism is perceived to be about applying general, scientic
knowledge to specic cases in rigorous and therefore routinized or institutionalized ways
(Noordegraaf, 2007, p. 765).
The professionalism based on occupancy has, however, been challenged because
professionals increasingly are part of larger organizations (Evetts,2009, 2011), and Schott
et al. (2016) have argued that ideas about professionalism have been shifting and that
professionalism is increasingly being perceived as embedded in a broad organizational and
societal context. In relation to social work, Llewellyn (1998a) argued that the high levels of
complexity of social services create uncertainty because of the lack of technical knowledge
about the nature of problems and their solutions. Consequently, it is difcult to
institutionalize professional control, and as Wällstedt (2017) emphasized, social works claim
to be a profession is challenged because social work does not form a sufciently coherent
body of abstract knowledge.
2.2 Resistance or adopting of accounting information
Research has shown that professional work can be reconciled with accounting techniques
(Kraus, 2012;Kurunmäki et al.,2003; Llewelyn, 1998a), that professionals can become
committed to nancial targets, and that they can be willing to accept nancial responsibility
(Lehtonen, 2007;Kurunmäki et al.,2003;Kurunmäki, 2004).
Contrary to these optimistic accounts related to the use of accounting information, it
must also be noted that the new responsibilities and the uses of accounting concepts change
or challenge, as many authors argued (Chow et al.,2019;Miller and Rose, 1990), core values
underpinning the identities of professionals. Research within social services (Carlsson-Wall
et al., 2016;Kraus, 2012) has shown that front-line professionals tend to resist accounting
practices that are perceived to be in conict with their clientsneeds(Carlsson-Wall et al.,
2016, p. 220). In general, professionals often respond with resistance (Liljegren, 2012;
Noordegraaf, 2015;Schott et al., 2016) because they perceive the introduction of new
accounting techniques and controls as threats to their autonomy (Buckmaster, 2018;Purcell
and Chow, 2011) or because the systems fail to consider and include professional unique
characteristics in their designs as shown by Abernethy and Stoelwinder (1995).
The increasing reliance on management accounting systems and accounting information
may lead to a weakening of professions as reective professional tasks become routinized
(Abbott, 1988) or when professional values are subordinated to nancial and administrative
tasks (Adcroft and Willis, 2005;Skærbæk and Thorbjørnsen, 2007). However, the use of
management accounting might also contribute to additional reective work procedures,
strengthen professional communication and reection and retain professional values
(Wällstedt, 2017).
3. Sensemaking perspective
On the basis of the earlier work of Weick (1979),Weick (1995) developed sensemaking as an
approach for understanding the process of organizing. We use sensemaking as a theoretical
lens (Lukka and Vinnari, 2014) to explore how managers, as a change agent, use accounting
information to improve cost-consciousness. Rather than focusing solely on the change-
process outcomes, sensemaking provides insights into how individuals and organizations
give meaning to events that are novel, ambiguous, confusing, or in some way violate
expectations(Maitlis and Christianson, 2014,p.57).
3.1 Sensemaking processes
Weick (1995) focused especially on how people enact, i.e. actively construct the environment
that they attend to by creating new features, which they pay attention to, in the
environment. This process is guided by the mental models of organizational members and
peoples sensemaking process is hence limited by their ability to identify and bracket cues (i.
e. isolate and focus on specic stimuli rather than other). Consequently, different people can,
in principle, bracket different cues in similar situations and hence actdifferently.
According to Maitlis and Christianson (2014, p. 59), sensemaking comprises three
interrelated and recursive processes or sensemaking moves.The rst move involves how
issues, events, or situations, wherein meaning is ambiguous or outcome uncertain, become
triggers for sensemaking. This implies noticing and extracting cues from the environment
and bracketing them. The second move involves the construction of intersubjective
meaning, e.g. when managers advocate for a particular understanding and attempt to
inuence othersunderstanding or when the sense is created as actors together establish
their understanding of an issue (Maitlis and Christianson, 2014, p. 78). Finally, the third
move involves actions, including acting to restore the sense of interrupted activity
(Sonenshein, 2010). Actions are an important part of the sensemaking framework because
along with creating cues that actors can focus on, they also provide provisional sense to be
tested through actions.
The two processes, sensegiving and sensebreaking, are especially important for
understanding how sensemaking is accomplished (Maitlis and Christianson, 2014). First,
sensegiving involves attempts to inuence the sensemaking of others. Sensegiving is often
studied in relation to how managers strategically inuence the sensemaking of
organizational members by using symbols, images, and other sensegiving devices (Gioia
and Chittipeddi, 1991). Such devices have, as Sandberg and Tsoukas (2015) argued, the
strength to actively alter and inuence the construction of the meaning of organizational
members, which, for managers, aims to reach a preferred interpretation of the change.
Second, sensebreaking dened as the destruction or breaking-down of meaning(Pratt,
2000, p. 464), is important as it motivates people to re-consider previously established sense.
Thus, sensebreaking can be used by managers to undermine present courses of action and
understanding before introducing new ways of doing things (Pratt, 2000).
However, given that sensemaking is a recursive social process (Weick, 1995), managers
are inuenced by the environment in which they engage (Maitlis, 2005). Additionally, as
argued by Maitlis and Lawrence (2007), when managers engage in sensegiving activities
with organizational members, they will be inuenced and will extract cues from them to
inuence their interpretations of the change.
Social work
3.2 Professionalssensemaking
Professionals make sense of changes and gure out ways to integrate new practices
(Thurlow and Mills, 2009;Kristiansen et al., 2015). The sensemaking literature does not
specically address the distinctive characteristics of a profession as such. Rather,
professionalism is conceptualized as mental models (Weick, 1995) acquired by professionals
during work, training, education and individual life experience (Weick, 1995;Avby, 2015),
helping professionals recognize and guide responses in daily practices (Weick, 1995).
Previous literature (Weick and Sutcliffe, 2003;Dunbar and Garud, 2009) has shown that
changes in work practices might not succeed in triggering the sensemaking of
organizational members if group norms or organizational cultures mitigate against it.
Instead, professionals may choose to accommodate, explain away or normalize discrepant
cues, even when the cues signicantly disrupt identity or goals. According to Sonenshein
(2010), organizational members may also actively resist efforts from managers to inuence
the changes on the basis of their own interpretations, or, as shown by Apker (2004), it may
result in professionals viewing change with ambiguity and impair the connection with their
work practices and the mental models guiding them. Further, Llewellyns(1998a)ndings
showed how social workers separated costs from care and indicated how changes in the
design of control systems were likely to trigger social workerssensemaking processes.
Consequently, initiating and engaging in sensegiving activities (Gioia and Chittipeddi,
1991;Maitlis, 2005) is crucial for managers to trigger sensemaking and inuence the
interpretation of organizational members with the aim of shaping the trajectory of change.
Thus, in the process of sensegiving, managers must understand and account for the mental
models of social workers and guide the process of change through a process that alters the
mental model and restores identity and goals according to the new work practices.
3.3 Role of accounting information and metaphors
Accounting information is important cues, for example, when deviations from expectations
are noticed and accounting information ismobilized through sensegiving processes, wherein
new numbers and operational causalities are enacted. Furthermore, the sensemaking
literature has emphasized that the use of accounting procedures and information creates
frames that reinforce action and create sustained action when actions are justied as part of
the sensemaking because a source of justication is simply to continue acting and
identifying the benets of the action (Swieringa and Weick, 1987, p. 304). Thus, accounting
information and procedures function as framing devices wherein accounting numbers
increase the persuasiveness of arguments (Goretzki et al.,2018).
However, an accounting frame is incomplete and needs to be related to other frames and
mental models to work as a sensemaking device as explained by Abrahamsson et al. (2016).
This can be achieved by relating accounting information directly to concepts meaningful to
organizational members in their daily work (Ahrens, 1997;Goretzki et al.,2018;Jönsson and
Solli, 1993). Nevertheless, it can also be done through the use of metaphors (Carlsson-Wall
et al.,2016) that link accounting concept representation and information metaphors, that is,
something to which it isnot literally applicable (Palmer and Dunford, 1996).
Individuals enact new mental models, which they typically perform through language
articulations. The rst language articulation is often a metaphor (Hill and Levenhagen, 1995,
p. 1062), which captures the tension between conceptualization and present. Such metaphors
are important rhetorical devices that generate new meanings, which go beyond those of
previous similarities (Cornelissen, 2005) and connect cues with mental models. For instance,
when managers explain previous actions to inuence othersunderstanding, metaphors
have a powerful role in validating some accounts and discrediting others(Maitlis and
Christianson, 2014, p. 83) providing justication for certain actions to others (Carlsson-Wall
et al.,2016;Cornelissen, 2012;Palmer and Dunford, 1996).
4. Methodology
4.1 Research site
The empirical part of the paper is based on a qualitative methodology. It explores
sensemaking activities related to the introduction of a need for improved cost-consciousness,
in the social service department of a Danish municipality (i.e. Alpha). Denmark has a long
history of providing publicly funded social services. The area is regulated by the Danish
Social Services Act, and the provision of social services is one of the signicant legal
responsibilities of the governments of 98 municipalities that work as closely as possible with
citizens and the local environment. The social services can be broadly divided into three
types: elderly care, special needs for children and special needs for adults. These services
exist per the Social Services Act and are regulated according to separate directives. The
different services are most often organized in separate departments within each
Alpha is a medium-sized municipality with approximately 65,000 inhabitants in the
vicinity of Copenhagen, the capital of Denmark. The municipality is organized into three
divisions according to the type of services provided: The City and Environment Division is
among other things responsible for roads, infrastructure, environmental issues, and various
kinds of permits for citizens and rms, whereas the Children and Culture Division is
responsible for kindergartens, basic schools, libraries and museums. Finally, the Social,
Health Care, and Work Division is responsible for services related to elderly care, health,
work, psychiatry and disability. Apart from these three service divisions, the municipality
has established transverse support departments for human resources, nance, and
digitization. In total, Alpha has approximately 7,000 employees [1], among which
approximately 850 are employed in the Social, Health, and Work Division. The Department
of Psychiatry and Disability (DPD) is part of the Social, Health, and Work Division and has
more than 400 employees.
The DPD is responsible for providing social services to adults above the age of 18 and is
organized with centralized teams and decentralized units. The centralized teams include a
quality and development team headed by the deputy manager, an administration team led
by the head of the department and a purchasing team headed by a purchasing manager. The
organization of the DPD is based on a so-called purchaserprovider split (Siverbo, 2004)
where the purchasing team is responsible for the purchase of services from provider units.
The tasks of the purchasing team include a professional assessment of needs and eligibility
with referral to residential homes, workshops and homecare based on adequacy and
following-up on progress for all client cases.
The decentralized part of the department comprises several provider units, including
residential homes of varying sizes and workshops for mentally and physically disabled
people, each led by a provider manager. Furthermore, the decentralized part of the
organization includes one larger unit delivering the entire services provided for people with
psychosocial disorders, including homecare, residential homes and workshops.
Alpha was chosen for this study because it has been studied by experts in the eld of
social services as being successful in balancing budgets within the social services.
Furthermore, the management accounting systems in Alpha were often mentioned as being
those of best-practices. Alpha has, for several years, been able to balance their budgets and
has developed systematic and comprehensive control systems. However, they have faced
nancial constraints owing to the overall poor national nancial situation. This has placed a
Social work
continuous focus on efciency and innovation in the use of resources, which has been
further pressured by new target groups as a consequence of increases in the number of
clients being diagnosed and becoming eligible for services. Consequently, Alpha developed
new management accounting principles and introduced new techniques and concepts to
create awareness among social workers to create cost-consciousness in social work.
4.2 Data collection
This study uses a qualitative methodology to address the research questions because
qualitative methods are well suited to the study of dynamic processes related to
sensemaking (Gioia and Thomas, 1996) and to comprehend complexity (Flick, 2009) akin to
processes of interaction between accounting and professional settings. Following the
sensemaking perspective, the accounts given by the managers through narratives, stories
and explanations are essential for retrospectively making sense of the disrupted activities
and their restoration (Sandberg and Tsoukas, 2015;Weick, 2001).
In the paper, we focus on the DPD in Alpha. From most municipalities, this area has
experienced higher expenses, greater difculties in complying with budgets and limited
insights into the cost and quality of social services compared with other parts of the public
sector. The study was conducted in May 2012 using semi-structured interviews and
documents from the municipality, including action plans and annual budget reviews.
We interviewed 13 individuals, including ve senior managers, ve middle managers
and three staff specialists. Senior management interviewees included the director and
deputy director in the Social, Health Care, and Work Division, the department head and
deputy head of the Psychiatry and Disability department, and the municipalitysheadof
Budgeting and Analysis. Interviews with middle management included the manager
responsible for purchasing and referrals in the DPD and four managers responsible for the
service provider units. Interviews also included two staff specialists from the DPD. Both
staff specialists were educated within social work and had many years of experience within
the eld. Further, a controller from the nance department was interviewed.
Although the number of interviews is less than that in most qualitative studies (Saunders
and Townsend, 2016) it should be noted that all senior managers at the Social, Health Care,
and Work Division as well as the DPD were interviewed. Out of a total of eight middle
managers in the DPD, we interviewed ve; four of them were responsible for service
provider units and one was the purchasing manager. However, the middle managers
constitute a fairly homogenous group, and the number of interviews was judged to be
sufcient to reach saturation.
The interview protocol was structured into six themes. The rst theme addressed
questions about the position, education and experience of the interviewee, and the second
theme focused on the organization and the interviewees view on the history of the
organization, along with the intervieweesviews on present and future challenges. This was
followed by a third theme, where interviewees were asked what they found to be the most
important aspect of the budgeting and planning systems. The fourth theme established an
understanding of how budgeting systems and professional competencies are related in daily
operations and the fth theme addressed how long-term planning was regarded and
prioritized, both as part of the budgeting and planning system and in daily practice. Finally,
questions within the sixth theme queried internal and external collaborations to understand
the level of inuence in daily practice, the political organization and its collaboration with
the administration.
The specic questions were open-ended to give managers an opportunity to introduce
and explain issues of concern in relation to the changes in the accounting information. Thus,
the interview protocol was governed by a need to enable the managers to contribute with
stories important to them, thereby making it possible to explore their processes of
interpretation that led them to make sense of changes and to decide if and how to engage in
activities to inuence organizational members and shape the path of change. Interviews
lasted between 1 and 2 h, frequently extending beyond the allotted time. All interviewees
were assured of condentiality.
4.3 Data analysis
In the analysis, we follow Sonenshein (2010)s methodological approach and use individuals
discourse to create a composite narrative to summarize the collective constructions of
meanings. In the analysis, the composite narratives are based on the interviewed managers
explanations, understandings and interpretations of the change process from which a
sequential structure (Pentland, 1999) was identiedto give meaning to events.
All interviews were recorded, fully transcribed, and, along with collected documents,
analyzed using the NVIVO ten qualitative software package. This made it possible to use a
systematic approach for data reduction, classication and interpretation to reduce the
qualitative datas analytical bias, which improved the studys reliability. It also improved
validity by making sure that a t existed between theory, research themes and what was
actually observed and identied during data collection and analysis.
The data were coded in three rounds. Initially, the coding was done to identify
management accounting and control elements, e.g. budgets,”“spreadsheetsand variance
analysis,as well as to mention accounting information and issues related to cost-
consciousness. Second, the data were coded to track the chronological structure of the
narrative, for example, by using codes related to the time of pressureon budgets and
identifying increasing costs.Finally, the data was coded using the theoretical concepts
from sensemaking theory to maintain a connection between the data and the analysis. The
codes used for the last part were divided into three groups: (1) environmental cues;(2)
interpretation,”“enactment of new work practices,”“understandings,and links;and (3)
sensegivingand sensebreakingpractices.
5. Findings
5.1 Move I: noticing and extracting cues
In the mid-2000s, Alpha introduced management by objectives within all divisions,
including a strict budget follow-up to make all departments comply with budget goals.
Nevertheless, DPD had been allowed to exceed budgets for many years or, as the head of the
department emphasized: nobody really knew how much money Alpha was spending on the
area of disability and psychiatry.The problem was that the nancial consequences of
referral processes of eligible clients to services were not registered in any system capable of
extracting cost information related to individual client cases. Consequently, the
departments management team did not have appropriate accounting information about
what services were purchased, for what period of time, and its related costs. Thus, it was
only after the bills arrived from the supplier that the department knew about the costs.
Given that the nancial resources were not unlimited, it was soon realized that major
changes were necessary. Management responded by implementing tools enabling the
department to obtain necessary nancial and nonnancial information, including
continuous budget follow-ups and service monitoring of client cases. This included
processes where caseworkers provide the nance department with information concerning
referrals to register data systematically.
Social work
These changes interrupted how the department accomplished things and forced the
organization to engage in sensemaking efforts concerning how to work and how to consider
costs. The information derived from the budgeting system became an important cue for the
management, indicating that something had to be done, and without further changes in the
budgeting and planning system, costs would continue to increase:
... we could see that we were using way too much money compared to the money allocated. We
could see that if we continued down this path, as new clients continued entering, we would never
have enough money to cover the expenses (Head of Department).
The management team found that they were unable to explain why costs increased year
after year and whether this was related to increases in the number of clients or the growing
needs of the clients already receiving care:
We had no idea how many [clients] were in residential homes and when bills came it sometimes
was like it was from someone we did not even know about. It is ve years since we developed the
Excel sheet all from scratch (Director).
As explained by the director, the department decided to develop an Excel sheet (Table 1)
that came to be known as the purchasing budget. This Excel sheet contained information at
a much more detailed level:
We have worked a lot on our purchasing budget, and we have developed an Excel sheet-based
tool providing information on the client and what services [...] and when new services have been
provided, we make sure to register them (Deputy Manager).
The purchasing budget included all relevant information about each client receiving social
services from Alpha and was anchored to daily work practice as the numbers could be
decomposed and related to clients and caseworkersdecisions in principle. Every time
referral to services was approved to a new client, the civil registration number was entered
together with the information about the type of service, the service provider and the legal
basis for providing the service as shown in Table 1. Further, the starting and expected end
date of the service and daily costs were entered by the caseworker. Then, the expense
estimate for the entire year was automatically calculated. If additional services were later
approved for the client, these services were added and any changes in duration or service
cost were entered into the spreadsheet.
In this way, the purchasing budget served a dual purpose. On the one hand, the
department controlled the budget by comparing it monthly with all service purchases and
update year-end spending prognoses. On the other hand, they followed-up on individual
cases, ensuring that client services remained adequate. Thus, the purchasing budget became
a tool used for the everyday control of costs, professionally as well as nancially. This way,
Table 1.
Structure of the
purchasing budget
Civil reg.
Type of
Daily rate
(euros) Start date
End date
(if decided)
yearly cost
Client 1 Psychiatry Workshop Carls Café SSA §103 60 01.01.2015 21.900
Client 2 Social
Homecare Team 1 SSA §85 40 01.01.2012 31.10.2012 12.166
Client 3 Disability Residential
The Corner
SSA §108 450 30.06.2004 164.250
Client 3 Disability Workshop BAS SSA §104 70 30.06.2004 25.550
it was possible for management to monitor costs and analyze deviations between
consumption and budgets down to the client level, including aggregates.
The department also used the historical data for prognosis and analysis of developments
in the number of clients and cost per client. Table 2 illustrates that the information was also
included as a note in the annual budget approved by the municipal Political Committee of
Psychiatry and Disability. Hence, updated information about the number of clients within
the overall target groups and expected costs were used for budgeting of the expected future
costs of service purchases.
The analysis initiated in Table 2 triggered an increase not only in total costs but also in
the clientsintake and social service demand from the dialog at staff meetings. However,
establishing an overall view of the reasons for the rising costs based on recent information
was not possible. Although the results in the spreadsheet were expressed in monetary terms,
the calculations reected professional future demand assessment.
The department head emphasized that before developing the purchasing budget,
conducting a detailed and precise analysis was impossible for DPD. Thus, the accounting
information from the analysis became cues for the management in the process of framing
the need for change. The management gained awareness of developments and the client
groups tendencies and how they increase costs. For example, the analysis showed an
increasing net intake within the client group with autism while also indicating new clients
tendency to enter Alphas social services, requiring additional service costs compared with
providing existing clients.
5.2 Move II: interpretation process
In 2010, the municipalities in Denmark were faced with a new budget constraint imposed by
the government. Consequently, for Alpha, it was necessary to reduce spending in all
divisions, and the deputy manager realized, [...] our nances are under pressure, because
the nances of the municipalities in general is under pressure.Although cost reductions
could be the apparent answer, the deputy manager interpreted the information from the
previous analyses and came to the conclusion that cost cutting was not an option. The cost
estimates expressed professional judgments and it was maintained that the needs of the
client were just as important as controlling costs:
At the same time, social service is a eld with lots of pressure, and the many eligible clients
entering, they need care, and these services are often very expensive. We cannot just say no, and
we dont wish to necessarily. But the challenge is enormous (Deputy Manager).
Table 2 shows that the deputy manager initiated several follow-up analyses related to the
budget note to further improve the budget. Table 3 shows the intake of clients previously
serviced by the Department of Children and Youth (DCY) that was analyzed for 20082010.
Table 2.
Format of the
analysis of the cost
structure included as
a note in the budget
approved by the
Political Committee
of Psychiatry and
Lowest price
Highest price
(euros) Median (euros)
Total no. of clients
in the target group
Psychiatry 15.000 135.000 40.00053.000 54
Physical disability 16.000 220.000 133.000200.000 46
Impaired mental functioning 2.200 493.000 93.000107.000 100
Autism 15.000 456.000 133.000145.000 33
Drug abuse 26.000 99.000 4
Social work
Thus, interpretation of the analysis results generated new understandings as the details of
the accounting information not only increased but also increasingly integrated professional
knowledge, which previously was not part of the overall budget. Analyzing the increasingly
detailed and complex information required interactions and close cooperation with
caseworkers, who had knowledge about the client case details. Specic areas and services,
such as demand increases in homecare-based services, were carefully scrutinized. Thus,
accounting information extracted from the analysis was important for the interpretation.
Further, the accounting information was used, not only among the managers but within the
organization and the overview gained from the spreadsheets proved to be useful for
managing the client cases.
The nancial challenge was also interpreted by management as an opportunity to
improve the quality of social work while simultaneously balancing the budget. Cost-
consciousness as a basic value in social work was enacted for controlling and directing
social work in the department rather than for cost reductions. It was recognized that
inadequate assessment of needs and eligibility and adequacy of services were the most
important cost drivers. Based on the detailed and precise accounting information extracted
from the analysis and its follow-up, the managements interpretation of the challenges
implied that improving social work practices and incorporating the nancial demands
would recreate order.
However, the interpretation was also connected to an initiative from top management,
which had resulted in comprehensive action plans for DPD developed to improve focus on
the rehabilitation of clients:
[...] we decided, here in the department, to apply a rehabilitating approach, which means that
we continuously have to assess when the client will become capable of taking care of himself.
What is needed for the client to become better, so they dont need permanent care, but perhaps
training enabling them to take care of themselves at a higher level. And that should also have
a spill-over eect making it possible to take in more clients in our homes and training
programs (Director).
As indicated by the Directors account, the focus on how resources were used had a
prominent place in the new strategy despite the overall focus on rehabilitation. Financial
targets or goals were not directly included in the plans, and the goals of the strategy were
attached to the nancial challenges, such as the following example. The goal with
rehabilitation is to make clients more self-reliant. That will release resources to clients with
increased needs(Disability action plan, 2020).
Even though the introduction of a rehabilitation perspective in social work was part of a
strategy for responding to eligible clientsintake increases and rising costs, the perspective
was also interpreted as a quality improvement initiative:
Table 3.
Analysis of intake of
clients in 20082010
2010 prices
Total intake
Average price
2008 (euros)
Total intake
Average price
2009 (euros)
Total intake
1. Quarter of
Average price
2010 (euros)
from DCY
Physical disability
from DCY
It is about being able to recover and being able to master your life, but we do not expect
everybody to recover fully. That is not a realistic goal of rehabilitation, but we believe that our
clients can be enabled to live a better life with their disability (Head of Department).
Managers interpreted the need for cost-conscious behavior in social work as being closely
related to professional competency, thus reaching an interpretation that suggested an
enhanced focus on costs in social work would only show full potential if used together with
strong professional competencies. One of the important cues leading to this interpretation
was the action plans focus on rehabilitation. For example, the purchasing manager
Now we all have to work in the same direction. Residential homes have to rehabilitate clients in
order for them to move on to another less intensive residential home or to their own home,
perhaps in combination with home care (Purchasing Manager).
Although the need for cost reductions triggered changes, management reiterated that costs
should not take precedence over the professional assessment of client needs or the provision
of care. Rather, cost-conscious behavior should include cost-effective solutions in the
assessment of clients by evaluating the possibility of alternative-but-sufcient services at
lower prices and an ongoing focus on providing services more adequately suiting the needs
of eligible clients through a rehabilitation approach.
Most managers emphasized that, over the long-term, insufcient care would increase
costs because services unable to meet the needs of the client would eventually result in the
need for intensied service:
You have to make sure not to go for short-term solutions and decide not to choose a service of
150.000 euros, but that of 75.000 euros which then is not sucient and then you have to change it
again. You never really know, but this is where professional competency becomes imperative.
You should never make decisions based on nances alone. That you should never do. It must be
founded in professional competency (Deputy Manager).
This understanding of the relationship between costs and care depended on how most
managers viewed professional social work, and professional assessments were enacted as
one of the most important tools for controlling costs. Although the information on the cost of
client cases had not been used in decision-making previously, the Head of Budgeting and
Analysis interpreted the focus on expenses as a reinforcement of already existing practices
because of the budget constraints imposed on the municipalities by the government:
I would not say that it is a new thing for Alpha to focus on being more ecient, because it has
always been that way, but somehow the pressure has resulted in it becoming more legitimate to
talk about how we actually do it the best way (Head of Budgeting and Analysis).
Consequently, the sustained focus on efciency became part of the sensemaking as a
justication to continue focusing on expenses andcost-consciousness.
When professional competency was enacted as the most crucial part of cost control, the
complexity of the nancial challenges was reduced, and further noticing and bracketing of
cues were guided by a shared understanding of the importance of improving competencies
and enhancing work practices. Consequently, managers noticed cues related to the daily
work practices among the social workers and found that the quality of social work had been
reduced not only by the previous lack of information but also by the lack of understanding
of how costs related to care.
The lack of nancial considerations was interpreted as plausible because, as one of the
staff specialists explained, social workers are educated about the legislation and that does
Social work
not include the nancing: It is a no go with this educational [background] to talk about
costs. You are simply notallowed to(Staff Specialist 1).
For some social workers, it was merely the ignorance of costs and not possessing an
understanding of the importance of controlling costs when nancial resources were limited.
However, for others, resistance to considering costs of social work had developed on the
basis of an understanding of costs as something that would mean less quality in the
provision of services. The purchasing manager explained how caseworkers would engage in
discussions about the level of service in regard to individual clients:
[...] if you said someone [client] was getting too much, then the response was that then we are
cutting back on disabled people. That was not seen as decent conditions (Purchasing Manager).
Noticing that part of the problem was an everyday practice where the professional approach
did not include any information about costs, managers focused on social workerslack of
either focus or understanding of costs, not to mention a shared responsibility for the costs
related to their work. In the bracketing of cues, this interpretation was important because it
indicated that the foundation for giving attention to costs had been absent for social
workers. How could they relate care with costs and take responsibility for managing costs
when information on the individual level was not available to them? The managers
interpreted the responses from social workers as a call for more assistance rather than only
being taught about budgets and costs. Consequently, further active managerial involvement
was needed to assist the social workers in making sense of cost information, and perhaps,
more importantly, for making sure a link was created between costs and care in professional
work practices.
5.3 Move III: restoring sense to the interrupted activity
Arriving at the interpretation that the mental model of the social workers had limited their
search for solutions, management had to break down sense to give sense. For the managers
to create a more cost-conscious behavior, they attempted to trigger and inuence
sensemaking processes among social workers. Many examples were provided on how the
combination of accounting information and metaphors could be used as devices. Moreover,
accounting information was used to clarify the consequences of the current work practices if
they were not changed and to demonstrate the importance of considering costs in social
As an example of how the new accounting information was used in the communication,
the department head explained how she introduced links between familiar understandings
of social work and a new practice of including considerations of costs related to homecare
services. On the one hand, the client case management team refers clients to homecare
services based on the assessment of their needs. On the other hand, the number of hours per
week that the client should be assigned homecare is determined. For some clients, the
service may be a few hours to allow them, for example, to read their mail and clean their
home, whereas other clients need additional intensive care and help to perform their daily
The department head was aware that caseworkers mainly focused on the professional
need assessment in the referral process. However, they also recognized a lack of
understanding of the connection between the allocated hours and related costs:
I talked to them about the assessment of clients for home care services. If each client gets just one
quarter of an hour less of the allocated hours, than it equals 3 employees. Is it really that much
money, they asked, and at that time it was around 130.000 euro. That made it clear to them, that
just one quarter of an hour less, adds up to a lot of money that we can spend on someone else
(Head of Department).
According to the head of the department, it was not important whether a quarter of an hour
was an accurate representation of needed changes because it had a symbolic meaning.
Neither was it questioned by the social workers; most would probably agree that one-
quarter of an hour less would not make much of a difference for most clients, hypothetically
speaking. The aggregation, however, came as a surprise. Whereas 15 min may not make
much of a difference in a single case, it is signicant when a large number of clients receive
home care. The deputy manager explained:
[...] If you see it from the point of a social worker, only responsible for a small group of
the clients, I understand why you would think it doesnt make that much of a difference
whether you make one or the other decision. But if you aggregate! And that is why it is
important for them to see the connection (Deputy Manager)
The sensebreaking processes started with the interpretation of the information in the
purchasing budget. However, the information also provided a new possibility for presenting
the calculation to the caseworkers and communicating in staff meetings. The calculation
used by the management in their analysis of homecare services is complex. Nevertheless, the
calculation presented to the caseworkers was simple and only included the most important
and aggregated numbers as shown in Table 4. This accounting information presentation
interrupted the caseworkersinterpretation of the relationship between costs and social
work as being disconnected.
A similar example was provided by one of the provider managers who noticed that costs
related to social workers having meals with clients in a residential home had increased. The
social workers appeared not to take into consideration how the costs of the meals affected
the budget because they did not have any information about it. Realizing it would be a
difcult task to talk about cutting back on costs and that it could easily end up being a
discussion about values and approach in social work rather than addressing the problem,
the manager made a simple calculation to provide the social workers with nancial
information and presented it at a staff meeting:
What we did was to set it up in an Excel sheet and ask them to have a look: this is what you spent,
and this is what is allocated. They were all blown away and completely chocked (Provider
Manager 1).
Showing the deviation between the allocated budget and how many resources were being
spent on the activity, it was clear to the social workers that the consequence of not
considering other solutions would mean fewer resources for the clients because
overspending on one activity would have to be nanced by the offset of others. Thus, the
manager broke sense in her group of staff using accounting information, thereby allowing
social workers to start new sensemaking:
I was waiting for resistance, but it did not come. They said that they got it, and that made me
think that you can indeed communicate nancial issues to this group. They understand it if you
Table 4
Illustration of
information targeting
caseworkers in the
purchasing unit
Cost reduction per week from
one quarter less per client
Cost reduction per year from one
quarter less per client per week
Total no. of clients
receiving home care
Total cost
20 1.000 130 130.000
Social work
do not give them the big Excel sheet but break it down into small units that make sense to them
and their daily tasks (Provider Manager 1).
Common for the examples is the use of accounting information together with a focus on
having enough resources available for eligible clients. This metaphor appeared to be very
strong for connecting new ways of doing things to the familiar practice and values of social
I dont say that we have to reduce. We have to be able to aord the next client coming through the
door, which are eligible for service and because we know they need service [...]. We will not
provide 8 hours to someone who only needs 1, if someone else is in a need of 7 hours, and we cant
provide that, because we dont have the money(Purchasing Manager).
Thus, accounting information strengthens the understanding of the metaphor,
simultaneously representing a break with the present practice. The Purchasing Manager
destabilized the present practice and sensemaking because it made sense to most social
workers that the consequences of not changing would be a lack of available resources.
However, as explained by one of the staff specialists, linking cost-consciousness with
professional competency was crucial to provide adequate care of high quality:
Our new motto has become best-less expensive which works because we will not compromise
with the clients life and its ok if things are expensive if its the most adequate. But if we can get
something equally good that is cheaper that is what we want. Anything else would be stupid
(StaSpecialist 1).
Although cost was given much weight, the managers focus on professional competency
was, therefore, emphasized even more. Competencies ensure that clients receive adequate
services, whereas a focus on costs would ensure the services provided were the most cost-
efcient ones capable of meeting the needs.
When probed to provide examples of how changes manifested, the managers emphasized
how cost considerations had become integrated into the social work practice. The
purchasing manager, for instance, explained:
From not considering costs at all they always take it into account now. We look at what needs
[clients] have, what our professional assessment tells us and what is sucient. They have not just
saved money; they have provided solutions that t instead (Purchasing Manager).
One of the staff specialists explained her own journey toward a more cost-conscious
I can see how I myself over the years have changed from being provoked by how much nances
inuenced professional decisions to understanding that if I as a professional only make
professional considerations and dont care about costs, it will end being the client paying the price
(StaSpecialist 2).
The managers also highlighted that social workers do not just take costs into consideration
because it is required of them. They understand that increased attention to costs has been a
necessary change in traditional social work and that provisioning has become more efcient.
The purchasing manager gave an example of how exactly the focus on costs has become
part of social work practices:
If the social workers realize that the home care provider has not been showing up for the last 3
months [...] Some clients are slow to react [.. .] The social worker calls, [the provider] themselves
and ask for a credit note. They would never do that previously. They have committed themselves
to participating in prioritizing what the money is spent on (Purchasing Manager).
Most managers agreed that the introduction of accounting information and integrating cost-
consciousness with social work had enhanced professional competence. Moreover, they
rmly believed that social workers agree:
Accounting is not something scary. The caseworkers take accounting information into
considerations in the professional assessments... Because our budget is under pressure we focus
on analyses (StaSpecialist 1).
Furthermore, a manager explained how the combination of focusing more on rehabilitation
and costs made it possible to change the approach in cases where clients need intensive and
therefore expensive services. Previously, these services were mainly considered from a
short-term perspective, whereas the focus has changed to include long-term perspectives in
a bigger picture, providing intensive services to enable clients to become more self-
You can come home and be proud that you just saved 65.000 euros because you did like this [...].
Being proud of nding a service that ts. Because they have not just saved the money. They have
provided something that is adequate instead (Purchasing Manager).
Likewise, provider managers expressed how it had become possible to engage social
workers more when prioritizing resources at their units. One manager explained, I inform
the staff [...] when we have a job opening. Together we will consider if we need this
position. But also, what do we need?(Provider Manager 2).
6. Discussion and conclusion
This study examines a Danish municipality where a need for improved cost-consciousness
was introduced in the social service department. We use sensemaking as a theoretical lens to
explore how managers, as change agents, used accounting information. Social work is often
seen as a complex matter (Devaney and Spratt, 2009;Schott et al.,2016), and social services
often struggle with achieving budget goals while delivering high-quality care as shown by
Llewellyn (1998a). In such settings, accounting information is often resisted (Buckmaster,
2018;Chow et al.,2019;Liljegren, 2012;Schott et al., 2016). Research has shown that middle
managers have a crucial role as change agents (Bukh and Svanholt, 2020;Deschamps, 2019;
Carlsson-Wall et al., 2016) when interpreting, using, and communicating accounting
information. We studied how the introduction of new accounting information inuenced the
understanding of cost-consciousness, managersuse of accounting information to frame
professional organizational membersunderstanding of the changes, and the impacts of
introducing a cost-conscious culture within social services on professional values. The study
makes several contributions to addressing these questions.
First, the study contributes to the cost-consciousness literature by demonstrating how
accounting information can link cost-consciousness to operational decisions in daily
practice. Velasquez et al. (2015) found in a literature review that cost-consciousness within
the management accounting literature was often vaguely dened or implicitly associated
with cost controls or generally focused on reducing costs and using budgets. Furthermore,
Velasquez et al. (2015) has found that cost-consciousness is associated with organizational
culture, suggesting a strong role of management control systems. Research has shown that
factors such as cost-management knowledge and cost-budget participation (Shields and
Young, 1994) and the availability of accounting information systems and informal authority
(Abernethy and Vagnoni, 2004) drive cost-consciousness. However, research on how
accounting, accounting knowledge and accounting information foster cost-consciousness in
practice is less clear. Hence, this paper lls this gap by showing how managers use
Social work
accounting information to link cost-consciousness to daily work, thus inuencing
organizational culture toward cost-consciousness.
When top management set directions and initiate tight control budgets, it may conict
with the demands at lower hierarchical levels where managers work closely with service
delivery (Dutton et al., 1997). Professionals often respond to resistance because they perceive
the introduction of new accounting techniques and controls as threats to their autonomy
(Buckmaster, 2018;Purcell and Chow, 2011) or because the delegation of responsibilities
fails to include front-line workers (Llewellyn, 1998b). In the study, middle managers did not
perceive accounting information as control or assert control over professionals. However,
the changes in improved cost-consciousness captured the trade-of between costing and
caringas described by Llewellyn (1998a; cf. Abernethy and Vagnoni, 2004, p. 213). Thus,
this study supplements extant literature by indicating that cost-consciousness involves not
only cost control and reductions but also the management of the trade-of between cost and
care in daily work.
Second, the study contributes to the literature on the role of accounting information in
public sector services by demonstrating middle managerscritical role in the introduction of
accounting information and accounting techniques. Similar to Carlsson-Wall et al.,2016,we
showed the effectiveness of metaphors when cost and needs are connected in daily practices.
Particularly, the study indicates that managers engaging in sensebreaking activities can
disrupt current practice with contradictory evidence, which is similar to Balogun and
Johnson (2004) as well as Martin-Rios (2016). The present study demonstrates the
effectiveness of sensebreaking and sensegiving using not only accounting information in
reporting and dialog with social workers but also accounting metaphors to demonstrate the
consequences of current practice and changes.
In the change process, new reporting forms were developed. The reports connected daily
decisions and work practices with overall budget objectives. The interpretation of these
reports generated new understandings as the accounting information details not only
increased but also integrated professional knowledge. This knowledge had not previously
been included in the budgets and budgeting process. The examples presented in the study
show that increasingly detailed and complex information requires interactions and close
cooperation with caseworkers who have knowledge about client case details. Although
client details may entail complexities, many of the reports used in the overall decision-
making aggregated details to highlight important information for decision-making while
simultaneously being consistent with client case details.
Many examples commonly show that accounting information is used to focus on
acquiring sufcient resources available for eligible clients. This perspective was highly
powerful when connecting new ways of doing things to the familiar practice and social work
values. In several cases, the importance of having resources available for eligible clients was
represented by numbers and metaphors that caused breaks in the scanning, interpretation,
and learning dynamics of the sensemaking process. In this way, sensebreaking actions
questioned, reframed and redirected attention because the sensemaking process is not about
truth and getting it right as Weick (1995) emphasizes. Rather, it is about redrafting an
emerging story that becomes more comprehensive, incorporates more of the observed data
and is more resilient in the face of criticism (Weick et al., 2005).
Carlsson-Wall et al. (2016) has shown how managers, as change agents, may succeed in
connecting new practices with familiar ones in a professional context using and verbalizing
metaphors. Similarly, this study emphasizes the importance of metaphors as a device used
by managers to facilitate cost-consciousness among professionals. The metaphors in the
present study were used in connection with accounting information that enables managers
to address values, norms, and beliefs within social work while also including the related
costs and their crucial part in providing quality social work.
Previous research (Schrøder, 2019a;Carlsson-Wall et al., 2016;Kraus and Lindholm,
2010) has pointed to the tradition within social services, where costs are calculated based on
how much time the social workers spent on the services(Schrøder, 2019a, p. 322). In the
study, the metaphors connecting time estimates and social practice with cost and budgets
are effective in the change process. Thus, accounting information simultaneously
strengthens the understanding of the metaphor and represents a break from the present
practice. The manager destabilized present practice and sensemaking because most social
workers perceived the consequences of no change as a lack of available resources.
Certain research (Llewellyn, 1998b;Nyland and Pettersen, 2004) has found that the
increased use of accounting techniques and information do not change core values and work
practices and that professional work can be reconciled with accounting techniques (Kraus,
2012). However, other researchers (Buckmaster, 2018;Chow et al., 2019;Liljegren, 2012) have
emphasized how professionals respond to resistance, especially when accounting practices
are perceived to be in conict with their clientsneeds(Carlsson-Wall et al.,2016,p.220).In
our case, when accounting information is accepted and integrated into social work without
much resistance, focusing on the information is not in conict with clientsneeds. However,
accounting information is interpreted by social workers as the key to accommodating
clientsneeds. Our results indicate not only an acceptance of cost-consciousness but also the
availability of relevant and interpretable cost information that links work practices to
budget achievement as an important antecedent for tight budget controls (Van der Stede,
2001) and social work quality.
Third, this study contributes to the literature on how management control inuences
professions and professional values (Abbott, 1988;Chow et al.,2019;Adcroft and Willis,
2005;Evetts, 2009;Noordegraaf, 2007;Wällstedt, 2017) by indicating how accounting
information may professionalize social work. Most research on the impacts of management
accounting on professional work has focused on health care (Malmmose, 2019;Van Helden,
2005), wherein professionals are expected to have legitimate expertise that is regulated only
by other professionals (Abbott, 1988) and where professionalism is perceived to be about
applying general, scientic knowledge to specic cases in rigorous and therefore routinized
or institutionalized ways(Noordegraaf, 2007, p. 765). In contrast, social work focuses on the
relationship with the client (Parton, 2008) and is based on the clients active cooperation
(Bracci and Llewellyn, 2012;Stewart, 1990), wherein complexity creates uncertainty because
of the lack of technical knowledge about the nature of problems and their solutions
(Llewellyn, 1998a). Consequently, institutionalizing professional control is difcult. As
Wällstedt (2017) emphasized, social works claim to be a profession is challenged because it
does not form a sufciently coherent body of abstract knowledge.
The changes in Alpha implied tighter control, and the management was more involved in
direction-setting. Thus, the study does not indicate a return to traditional job-based
professionalism (Evetts, 2011) but rather a change in professionalism wherein
organizational professionalism increases importance within social work. By incorporating
the accounting information to social work practice, it became possible for the social workers
to sustain focus on the relationship (Parton, 2008) and to reect on their current work
practices. Furthermore, the results of the present study indicate that cost-consciousness can
be linked to professional practice. Thus, professionals are allowed to use new accounting
techniques to align with professional work while increasingly becoming cost-conscious
(Llewellyn, 1998a;Kurunmäki, 2004). Thus, this study contributes to the extant literature by
highlighting how professionalism may be strengthened based on accounting information
Social work
use. Although Chow et al. (2019) suggested that social work professionals could reassert
their epistemology based on accounting information, they concluded that it was a distant
possibility because managerialism retains it stranglehold on social work.Our study
indicates that this future may not be verydistant.
When the managers engaged in the design and development of accounting tools,
principles, and methods to meet new demands of the budgeting system, the accounting
information inuences managersbehavior, as also shown in previous studies (Kraus, 2012;
Kurunmäki, 2004). By allowing managers to inuence the process of implementing change
and the design of the control system within the frames dened by top management, the
managers use it to build sensegiving activities aimed at shaping organizational members
sensemaking processes and to inuence how costs become linked to social work.
Interpreting the result from the study, two observations in relation to the change process
appear to be of importance.
First, managers connected local changes in social work to other ongoing change
processes by extracting cues from the new accounting information and connecting
them with cues from the ongoing change processes in the organization. In this way, a
shared interpretation of the related changes emerged, contributing to the managers
belief that the changes provided higher levels of quality care despite considerably
stricter controls and demands for complying with budget goals. This indicates, as
Swieringa and Weick (1987, p. 304) pointed out, that accounting can reinforce action
when actions are justied as part of the sensemaking, because the sustained action
created by self-justicationbasedonspecic accounting procedures provides a strong
context for commitment.
Second, the study indicates that the managers had considerable inuence in shaping the
changes in the management accounting systems. Initially, the change was introduced from
top management as a response to the demands of changes in nancial conditions and
external demands for tight budget controls. However, the changes were just as much the
result of interpretations and decisions at lower organizational levels. The managers
interviewed in this study appeared to exercise substantial inuence on the changes not only
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About the authors
Per Nikolaj Bukh , MSc, PhD, is a professor at the Department of Business and Management, Aalborg
University, Aalborg, Denmark ( He has published articles and books on several
subjects, including budgeting, management accounting and control, payment by results and strategy.
In addition to his research activities, Per Nikolaj often contributes to postgraduate programs and
conferences. Per Nikolaj Bukh is the corresponding author and can be contacted at: pnb@pnbukh.
Karina Skovvang Christensen is an Associate Professor at the Department of Economics, Aarhus
University, Aarhus, Denmark. She has published articles and books on several subjects, including
knowledge management, formula funding and strategy.
Anne Kirstine Svanholt, M.Sc., is the Head of the Center of Drug Addiction Treatment
Copenhagen, Municipality of Copenhagen, Denmark. She will submit her doctoral thesis on
management and accounting in social services in 2021. Before enrolling in the PhD program at
Aalborg University, Aalborg, Denmark, Anne Kirstine was employed in various administrative and
managerial positions in the public sector.
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This study reviews 317 accounting studies in health care from the past 40 years. In addition to a traditional description of the theory and methods applied, this review focuses on the countries that have been studied, the stakeholder perspectives that have been represented through data collection and the longitudinal accounting topic focuses that have been developed. The findings illuminate trends and gaps in the literature. Specifically, this study identifies a growing trend of applying interviews as a method of data collection, which increases the possibility of representing individual stakeholders. Predominantly, administrators’ and doctors’ viewpoints are presented, whereas a lack of perspectives among nurses, patients, and politicians raises opportunities for future research. Additionally, there has been an increase in the number of countries represented in studies. Whereas Scandinavian countries are well represented in this literature review, studies of non‐English‐speaking countries are still significantly lacking. The accounting topic in focus has seen a natural development with New Public Management (NPM) reform developments. A majority of costing and budgeting studies in the 1980s and 1990s have gradually changed to a performance measure focus and different atypical areas, signaling increased nuances in the role of accounting in the health care sector. Thus, although the majority of the existing accounting literature has focused on NPM market reforms, NPM health care reform is far from exhausted, and ample opportunities exist for future research in health care accounting.