Informal acquisition of accounting literacy and the use of accounting information by clinicians at the board of clinical commissioning group

This thesis discusses how clinicians align their logic with the objective of the organisation that they work for, leading to informal acquisition of accounting literacy and the use of accounting information. The study uses institutional logic theory to explain the transformation that takes place as clinicians work alongside accountants. Data were gathered from document analysis, participant observation and semi-structured interviews with GPs, nurses and pharmacists. Drawing on institutional logic theory, the study argues that the objectives that clinicians intend to achieve when they join the management team differ from those of the organisation. However, as they learn about the organisation’s specificities such as its politics, budgetary process, and public expectations, their perceptions of what is possible align with those of the organisation. The alignment of these diverse types of logic manifests in the form of trust, minimal conflict and a shared vision, even though the different groups are not necessarily in agreement about the best way to rationalise services. Consequently, the different groups can work together in harmony and allow some actors to direct certain activities while other actors shape different activities but decisions must be justified with sufficient information. The alignment of logic and teamwork fosters informal learning through three processes: attachment to managers; hearing the same information repeatedly; and participation in goal-driven activities. Interdependency between clinicians and accountants and their shared visions are the two key factors in facilitating the informal learning process. The knowledge acquired is then used in decision-making, to influence behaviour, and for the purposes of education and negotiation.