The role of disciplining/translating accounting practices in patient-centred care

Purpose - This paper aims to offer a critical pathway to understanding recent changes and improvements in organizing and managing healthcare - such as the emerging "patient-centred care" ( PCC) approach. Design/methodology/approach - The research is based on fieldwork performed as a mobile ethnography of translations of everyday healthcare work at a Swedish healthcare institution in which an analysis of the significance of contemporary accounting practices for disciplining action and thought was carried out. Findings - Accounting is increasingly interlinked with medical practices today, with more and more people involved in translating action and thought into accounting-based terms and values at all levels of their work lives; as this happens, accounting "produces" a way of thinking and valuing that even modifies professional identities. The discipline of medical knowledge is played out differently as accounting-based valuation measures become internalised into the performance of medical professionals and as additionally their images of themselves and their patients change. Patient-centred care is thereby seen not as a means of generating a pure or positive value for patients, expressed in the form of greater efficiencies and nation-wide performance indicators. The loosely coupled forms of patient- centred care are about how nurses, having translated accounting practices into their work and selves, use them as a means of managing the constraints and "cracks" in the PCC approaches. Originality/value - Accounting allows the dynamics of the PCC approach to be understood and acted on in new ways. Accounting as a discipline involves both accounting professionals and medical professionals who circulate accounting numbers and values. Accounting, thus, is an activity that takes place inside and outside the self.