تغییرات رفتاری به دنبال توسعه مشترک یک سیستم اطلاعاتی حسابداری

This research examines physician response to implementation of an activity-based costing (ABC) system developed and designed with physician input. We analyze changes in resource utilization for treatment of cataract patients and find changes in practice patterns, where physicians redeployed resources toward more severely ill patients and decreased average length of stay. We also find preliminary evidence of improvement in financial performance. We contribute to research investigating the influence of user participation on accounting system success, ABC system success, and hospital accounting information systems.

This paper examines an aspect of activity-based costing (ABC) information systems that has been overlooked in prior accounting research literature: whether non-accountant participation in the development of the information system influences the participants’ resource allocation decisions after system implementation. This participatory aspect of system development is crucial in professional settings because accounting information tends to be ignored by decision-makers as they allocate resources (i.e., Bergman, 1994). Our study is a joint test of the effects of user participation in designing an ABC accounting information system and the consequent behavioral changes by the participants. We provide insights into the dynamics and success of system implementation. Our study provides a particularly useful setting in which to examine the impact of participation on system success because participation is a key element of ABC system design (i.e., Hunton and Gibson, 1999, Ives and Olson, 1984 and Shields, 1995). Prior research suggests that systems are more likely to be accepted and considered successful if users are involved during system development; however, evidence of this is inconclusive (i.e., Lynch & Gregor, 2004). The professionals we study are physicians from the ophthalmology department of a hospital who perform cataract surgery on both inpatients and outpatients. We investigate implementation of an accounting information system that developed standard costs by incorporating the physicians’ knowledge about their activities and use of resources. We test whether implementation of this new accounting information system led to cost containment behavior by examining resource utilization changes. The new system was the result of a collaborative effort between physicians and hospital accountants at a large government-owned hospital in Taiwan. Development of the standard cost system was a two-stage process. First, physicians were asked to use an activity-based costing approach to develop cost information. They then used this information to analyze current clinical pathways (standard treatment protocols) and to develop new, more cost-effective pathways, with corresponding standard costs for the department. Physician involvement in the process appears to have affected their behavior. They ignored information from the previous standard cost system, but appeared to use information from the new system to reduce resource usage and overall patient costs.1 After the new system was in place, there is also evidence that physicians changed their behavior and decision-making as they redeployed resources and focused on sicker patients. Our results have implications for healthcare and other professional organizations where professionals make decisions about resource use, and thereby, the financial performance of the organization. Typically, professionals are not involved in accounting information system development. Our results suggest that including professionals in system development may lead to changes in behavior and improve their resource allocation decisions. We contribute to several streams of accounting research literature. Prior research on the benefits of user participation gauges system performance by measuring self-reported user satisfaction scores (i.e., Foster and Swenson, 1997, Shields, 1995 and Swenson, 1995). We provide empirical results indicating that involvement in system design leads to actual changes in resource deployment and improved financial performance. This study is also one of the first to identify non-accountant participation as a crucial factor in the success of ABC information systems. The remainder of the paper is organized as follows. Section 2 sets our study within a theoretical context and develops our hypotheses. Section 3 presents a description of the study setting and describes our data collection and research methodology. Section 4 describes results of our empirical tests and Section 5 concludes the paper.

To our knowledge, the inherent linkage between ABC implementation and non-accountant participation has not been explored in prior research. A key feature of ABC is that employees who perform productive tasks are asked to help identify cost pools and cost drivers. This involvement takes place as part of the analysis and design phase and should lead to greater use of the system (Hunton and Price, 1994 and Ives and Olson, 1984). When an ABC system is used in a professional setting, the professionals become involved in analyzing their activities and designing the system and consequently, the system should more likely affect their behavior than would a traditional information system developed by accountants. We explore this issue in a healthcare setting where a subset of physicians admits that they had ignored traditional accounting reports, much to the frustration of hospital accountants. Our study setting is the ophthalmology department in a large hospital in Taiwan. The previous costing system was based on average costs and was developed by the accounting department. The new system required that physicians examine the inputs to their treatment decisions, including their time, clinic employee time, and all supplies used to develop activity-based cost pools and cost drivers. Once this cost information was developed, physicians were asked to use it to reassess clinical pathways that had been developed previously. The modified clinical pathway information became new standard costs for the department. Physicians were thus highly involved in developing the new system. This involvement linked cognitive and motivational factors to the ultimate success of the system because as the physicians report, they were willing to use the new information, whereas they had ignored information from the old system. Further, new disaggregated information reported the costs of their activities in patient care, teaching, and research. Because revenue was received only for patient care, the new report allowed physicians to better gauge the effects of their activities on both costs and revenues. Our hypotheses predict that physicians would change their resource consumption decisions after system implementation to align with the system goals. We find that after implementation physicians reduce resource utilization for inpatients and perform more procedures on an outpatient basis. Resources used per procedure decrease for all patients. Further, we find that physicians use hospital resources more efficiently. Overall, cataract inpatient length of stay decreased, as did the length of stay associated with additional procedures. Resources appear to have become more focused on patients who are more severely ill; length of stay is more positively associated with the patient’s number of conditions after the change in cost system. We also examine the overall effects of the system implementation on financial performance. We find preliminary evidence of improved financial performance after implementation through both increased revenues and decreased costs. We contribute to the literature that examines the influence of participation in accounting information system design and other factors on post-implementation outcomes. For example, Choe (1998) uses self-reported satisfaction and use as proxies of system performance success. His results suggest that task uncertainty and specific information characteristics influence the success of user participation in system design. Satisfaction with the accounting information system was highest when task uncertainty was high, information was aggregated and timely, and user participation was high. Hartwick and Barki (1994) review research findings concerning information systems and how users’ participation influences their post-implementation beliefs that: (1) the system is important and personally relevant; and (2) that they would be more inclined to use the system. A weakness of this line of research is that success is measured by self-reported satisfaction and use. We also contribute to the hospital accounting information system literature. Kim (1988) analyzes responses from business managers and hospital accounting information system directors from 28 US hospitals and finds that characteristics of the tasks, problem analyzability, coordination methods, and group size affect the performance of hospital accounting information systems. Measures of system performance are self-reported beliefs about satisfaction with the system, and include perceptions about system qualities such as accuracy, amount, and understandability, among others. We add to this literature by providing evidence that participation in developing an ABC information system resulted in post-implementation improvement in resource utilization. These results are consistent with Hunton and Gibson (1999), who find improvement in error rates when employees participate in the design and development of a new accounting information system. Our results show not only a reduction in overall resource utilization, but also a redeployment of resources toward sicker patients. Our approach and research question are somewhat different from Bhimani (2003). His work examined how organizational culture became embedded in a new accounting system and how alignment of personal culture with the organizational culture expressed in the system affected perceived success of the system. In his study, while not specifically investigated, statistics on culture scores indicate that the system did not appear to play a role in changing personal culture. Using similar terminology, we believe that in our setting the new system helped to better align the personal culture of the physicians with the organizational culture that management had been trying (unsuccessfully) to embed in the hospital. In a sense, the new system did a better job of expressing the belief system that the hospital was trying to communicate. The result is that the physicians were more willing to consider cost in their treatment decisions. Prior research on the success of ABC system implementations has ignored the effects of participation on both the system users’ perceptions of success and the systems’ successes. Future research analyzing ABC system success needs to consider the effects of user involvement. While prior ABC research examined users’ beliefs and attitudes to help identify successful implementations, no one has directly measured user input throughout an ABC system implementation to determine the influence of such involvement on the use and success of the system. In addition to underscoring the importance of considering user participation in analyzing system success, our study illustrates the importance of examining changes at a more micro level. The change in resource utilization that we found is not merely comprised of cost reductions. Our analysis of resource redeployment toward outpatients and more severely-ill patients provides a much richer description of the impact of the system change. Our study is subject to several limitations. We did not formally survey physicians to determine the extent to which their involvement in system development influenced their willingness to use information produced by the system. However, we are able to capture behavioral changes that occurred post-implementation that suggest physicians did use the new information. Anecdotally, one physician told us that he paid attention to the new cost information because, rather than being seemingly arbitrarily assigned by the accountants, the costs were now “real.” This is a particularly striking statement, given that the difference between the pre- and post-ABC standard costs ranged from 2.6% to 3.1% – an amount that is unlikely to make a material difference for most decision-making contexts. In addition, while our study sample period is somewhat limited, our results hold at both the beginning and end of the sample period, indicating that the improvements are unlikely to be a temporary phenomenon. We also did not track costs to develop and implement the ABC system to know whether the department cost savings outweighed the costs of accounting department time and effort. There are features of our setting that potentially limit the generalizability of our findings. Future research could investigate these characteristics to help better understand how participation can help with system success. First, the professionals that we study are physicians. Cost considerations are not a part of their education or culture. It may be the case that we find results due to the educational aspects of the ABC process—the physicians developed a better understanding and appreciation of cost. It might be interesting to investigate whether there are similar improvements in a setting where cost is a part of the professionals’ education and culture, such as in an accounting firm. Another characteristic of our setting is that it is fairly simple—ABC was introduced for only two processes (inpatient and outpatient treatment of cataracts), there is a culture of developing treatment protocols, and there are limited opportunities for resource substitution (e.g., many tasks that physicians perform cannot be performed by nursing staff). Future research could investigate how systems such as ABC impact decision-making in more complex settings where there are more activities to manage and more substitutable resources, such as the banking industry. Finally, ABC systems do not fully separate fixed and variable costs. In the setting for this study, capacity utilization is quite high, so the opportunity cost of capacity is a clear consideration. Inappropriate inclusion of overhead is likely more of a concern in organizations that have excess capacity and ABC systems may not result in similar improvements. Some newer accounting information systems, such as GPK (Grenzplankostenrechnung) and RCA (Resource Consumption Accounting) have the participatory features of ABC, but more carefully separate fixed and variable costs. Future research could examine the effects of participation and resource utilization changes in these types of systems relative to ABC and capture any differential impacts of these systems based upon capacity utilization.