An institutional perspective on management accounting change in the public sector : a case study from Canada

This thesis reports on a four-year field study conducted at the Saskatchewan regional office of the Department of Indian Affairs and Northern Development, a large department of the Government of Canada. Over the course of the study, a sweeping government-wide accounting reform took place entitled the Financial Information Strategy. An ethnographic study was conducted that documented the management accounting processes in place at the regional office prior to the Financial Information Strategy reform, the organization’s adoption of the new accounting system associated with this initiative, and the state of the organization’s management accounting system once the implementation was complete. This research, therefore, captures in detail a management accounting change process in a public sector organization. This study employs an interpretive perspective and draws on institution theory as a theoretical framework. The concept of loose coupling and insights from the literature on professions were also employed in the explanation-building process for the case. This research contributes to institution theory and the study of management accounting change by recognizing conflicting institutional forces at the organizational level. An existing Old Institutional Economics-based conceptual framework for management accounting change is advanced and improved upon through the development of a new conceptual framework that incorporates the influence of wider institutional forces, the concepts of open and closed organizational systems and loose coupling, and the recognition of varying rates of change and institutionalization of organizational activity sets. Our understanding of loose coupling is enhanced by the interpretation of institutional influences developed in this study as is the role of professionalization as a normative influence in public sector organizations.

Medication discrepancies at transitions in pediatrics:a review of the literature

Medication reconciliation is an important process in reducing medication errors in many countries. Canada, the USA, and UK have incorporated medication reconciliation as a priority area for national patient safety initiatives and goals. The UK national guidance excludes the pediatric population. The aim of this review was to explore the occurrence of medication discrepancies in the pediatric population. The primary objective was to identify studies reporting the rate and clinical significance of the discrepancies and the secondary objective was to ascertain whether any specific interventions have been used for medication reconciliation in pediatric settings. The following electronic bibliographic databases were used to identify studies: PubMed, OVID EMBASE (1980 to 2012 week 1), ISI Web of Science, ISI Biosis, Cumulative Index to Nursing and Allied Health Literature, and OVID International Pharmaceutical Abstracts (1970 to January 2012). Primary studies were identified that observed medication discrepancies in children under 18 years of age upon hospital admission, transfer and discharge, or had reported medication reconciliation interventions. Two independent reviewers screened titles and abstracts for relevant articles and extracted data using pre-defined data fields, including risk of bias assessment. Ten studies were identified with variances in reportage of stage and rate of discrepancies. Studies were heterogeneous in definitions, methods, and patient populations. Most studies related to admissions and reported consistently high rates of discrepancies ranging from 22 to 72.3 % of patients (sample size ranging from 23 to 272). Seven of the studies were low-quality observational studies and three studies were 'grey literature' non-peer reviewed conference abstracts. Studies involving small numbers of patients have shown that medication discrepancies occur at all transitions of care in children. Further research is required to investigate and demonstrate how implementing medication reconciliation can reduce discrepancies and potential patient harm. © 2013 Springer International Publishing Switzerland.