Management Accounting And Supply Chain Performance Of Healthcare Institutions In Ghana

ABSTRACT

This work analyzes the contingency effects of supply chain integration (SCI), information sharing (or knowledge exchange), supply chain (SC) risk and uncertainty and management accounting system (MAS) design on hospital SC performance in Ghana. Increasingly seen as crucial in the management accounting (MA) literature over the past three decades has been the design and implementation of effective MASs that extend beyond organizational boundaries for the management and performance of relationships in the inter-firm exchanges domain. Such studies have become one of the most important and critical areas for the CEOs and executive leaderships of hospitals in their efforts to improve operational efficiency at minimal costs. However, while the relationship between several SCM contextual factors and MAS information, and the impact of SCI on SC performance have been extensively examined, virtually no study had empirically examined in a single comprehensive study, the SCM-performance impacts of MAS design. The underdevelopment of such studies is even more pronounced in service oriented organizations. In addition, the literature on MAS-SCM relationships had emphasized the design of MAS in the transaction context which in most cases results in misaligned control. Transactions costs economics (TCE) although provides insights on the MAS organizations should install to achieve fit, the actual observed patterns of MAS use and the contextual factors that underpin MAS design in the inter-firm exchanges domain are not fully explained by the theory. Hence, TCE tends to ignore the dimensions of internal fit (i.e. internal integration) of the SC. Given this void, a survey of management accountants drawn from 237 public and private hospitals in Ghana was used to test the contingency effects of these relationships on hospital supply chain aggregate performance using hierarchical factorial structures. Whereas the results partially support the presence of the selection and mediation fit, the moderating form of fit was fully supported by the sample data. Also, internal

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integration was only supported by the moderation fit model. However, level of information (or knowledge) exchange was not supported by the selection fit model although it was fully supported by the moderation fit model and partially supported by the mediation model. This finding suggests that choices of the MAS information characteristics to facilitate SCM decisions among hospitals in Ghana is either excessive or insufficient. However, the findings suggest that optimal choices of MAS design in the inter-firm exchanges domain to enhance SC operational performance can be explained by contingency theory. Consistent with several prior studies, it can be theorized that SCI as well as level of knowledge exchange and SC risk and uncertainty have contingency effects in the design of MAS in the inter-organizational domains in healthcare context. Hence, they could be considered as added external variables in the MAS-contingency paradigm. The study’s key contribution is the development and testing of a novel theoretical model of the relationship between the selection, mediation and moderation fit models that link SCI, level of information sharing, and SC risk and uncertainty and MAS design on hospital SC performance. It also offers Ghanaian hospital managers the usefulness of the MAS-contingency framework in enhancing hospital SCM decisions.