EU-US S&T Collaborations, Challenges and Opportunities for Development. Innovation Diplomacy, Special case in point: the Hellenic-American innovation bridge and its underlying dimensions. ACES Working Papers, October 2012

Developed and developing economies alike face increased resource scarcity and competitive rivalry. Science and technology increasingly appear as a main source of competitive and sustainable advantage for nations are regions alike. However, the key determinant of their efficacy is the quality and quantity of entrepreneurship-enabled innovation that unlocks and captures the pecuniary benefits of science enterprise in the form of private, public or hybrid goods (for instance, bio-entrepreneur-millionaires, knowledge for the public good - ie: public health awareness, and new public-private research centers funded partly by bio-entrepreneur-millionaires and monies levied as taxes on bio-ventures).

Promoting the agenda for a social Economic and Monetary Union: Attention, credibility and coalition-building. Bruges Political Research Paper No. 37, November 2014

In the aftermath of the crisis, new instruments of economic governance have been adopted at the EU level. Until recently, these have been strongly dominated by what I assume to be the ECFIN coalition. However, at least since 2011, this coalition’s supremacy has been challenged by the competing coalition’s (EPSCO) willingness to rebalance the economic governance so that social concerns are better taken into account. Hence, drawing on the agenda-setting literature in the EU context, this working paper aims at retracing the process that has led to put this issue of the social dimension of the EMU on to the EU political agenda. Three hypotheses are made concerning the rise of this issue, the strategies employed by agenda-setters, and the policy subsystem of the economic governance. First, this study shows that the interest in this issue has been gradually fostered ‘from below’, at the level of the European Parliament and the European Commission. Second, due to its ‘high politics’ nature, this issue could only be initiated ‘from above’ (European Council) and then expanded to lower levels of decision-making (Commission). Specifically, DG EMPL has managed to attract attention to this issue and to build its credibility in dealing with it by strategically framing the issue and directing it towards the EPSCO venue. Finally, I analyze the outcome of this agenda-setting process by assessing to what extent the two new social scoreboards which form part of this social dimension have been taken into account during the 2014 European semester. The result of this analysis is that the new economic governance has not been genuinely rebalanced insofar as its dominant policy core remains that of the ECFIN coalition.

Die deutsche Verwaltungswissenschaft und der Ideenimport aus den USA. Über den Einfluss der USA auf die Entwicklung der deutschen Verwaltungswissenschaftstradition während des Deutschen Reichs, der Weimarer Republik, der Zeit des Nationalsozialismus und der Bundesrepublik Deutschland von 1870-1970

Die negativen Vorurteile betreffend Ineffizienz der Verwaltung und Behördenfaulheit stehen in krassem Gegensatz zum Einfluss, den die Verwaltung in der Regelung des alltäglichen Lebens einnimmt. Die Rolle der Verwaltung nahm parallel zur Entwicklung des modernen Staats laufend an Bedeutung zu. Dabei verschob sich zunehmend der Gestaltungsraum von den politischen zu den administrativen Institutionen. Die Verwaltungswissenschaft setzt sich mit diesem Wandel auseinander. Daraus folgen verschiedene Fragestellungen: Gibt es ein genug, ein zu viel oder zu wenig an Staat? An wessen Interessen sollte sich die Verwaltung orientieren, wenn sie ihre Aufgaben gut erfüllen wollte: Dem Souverän oder der Exekutive? Dem Monarchen, dem Volk oder der stärksten Partei? Oder soll sie sich auf das Gemeinwohl ausrichten – so undefiniert dieser traditionsreiche Begriff ist und auch ausschliessende, z.B. völkische, Prinzipien zu umfassen vermag? Oder gelten für die Verwaltung eher abstrakte Maximen wie Rechtsstaatlichkeit, Effektivität oder Effizienz? Die bekanntesten Schlagworte der Verwaltungswissenschaft dürften „Bürokratie“ und „New Public Management“ sein. Beide Begriffe sind stark politisiert und auch in ihrer Bedeutung umstritten, wobei letztere auch nicht der Verwendung im wissenschaftlichen Diskurs entspricht. Dies ist aus bedauerlich, weil es die gesellschaftliche Auseinandersetzung betreffend dieses wichtigen Faktors staatlicher Organisation verhindert. Für die verwaltungswissenschaftliche Auseinandersetzung bedeutet dies vor allem eines: Sich der divergierenden Bedeutungen von Begrifflichkeiten bewusst zu sein. Hier stösst man allerdings auf ein wesentliches Problem: Während die Bedeutung in der öffentlichen Diskussion notorisch unscharf ist, kennt auch der wissenschaftliche Diskurs keine klare Definition der Verwaltung, der Verwaltungswissenschaft oder verschiedener verwaltungswissenschaftlicher Konzepte. Die Schwierigkeit, die Verwaltung und ihre Bereiche zu definieren, kann als Versagen der Wissenschaft verstanden werden (Ellwein, 1966: 15; von Stein, 1965: 2384) oder auch daran liegen, dass das Unterfangen prinzipiell unmöglich ist (Forsthoff, 1973: 1). Auf jeden Fall zeigt die komparative Verwaltungswissenschaft, dass Begriffe und Konzepte aus fremdsprachigen Publikationen und deren Kontext übernommen wurden. Besonders deutlich wird dies darin, dass in der Management-Literatur oder der Policy-Forschung die ursprünglich englischen Begriffe im deutschen Sprachgebrauch ebenfalls verwendet werden. Aber die Bedeutungen der ursprünglichen Ideen haben sich während des Transfers in den neuen wissenschaftlichen und politischen Zusammenhang geändert. Daraus folgt eine zweite Problemdimension, die bereits von Woodrow Wilson (1941 [1887]) im Gründungsdokument der US-Verwaltungswissenschaft aufgeworfen wurde: Für welchen Bereich kann die Verwaltungswissenschaft eine Gültigkeit beanspruchen? Wilson argumentiert, dass die Verwaltung als eine Technik zu betrachten sei. Als solche sei sie unabhängig vom politischen Kontext gültig, weswegen er vorschlug, die USA sollten sich in der Suche nach der besten Staatsverwaltung am preussisch-deutschen Modell zu orientieren. Analoge Gedankengänge können auch in der deutschen Verwaltungswissenschaft festgestellt werden, wenn sich die Forschenden auf ausländische Inspirationen beziehen. Die Forschenden suchen dabei Antworten, die unabhängig von ihrer Herkunft auf die eigenen politischen, ökonomischen oder sozialen Problemstellungen gemünzt sind. Diese Probleme – genauso wie die Lösungsansätze – können globale sein, orientieren sich in der Regel jedoch an den eigenen nationalen Institutionen. Denn nur von diesen können sich die Forschenden erhoffen, dass ihre Lösungsvorschläge in die Praxis umgesetzt werden. Basierend auf dieser Argumentation schliesst die aktuelle komparative Verwaltungswissenschaft auf nationale Traditionen der Verwaltungswissenschaften, die den spezifischen Staatsverständnissen entsprechen (Raadschelders und Rutgers, 1996; Rutgers, 2001b; Stillman, 2001). Dabei werden zwei wesentliche Faktoren ausgeblendet: Erstens wandelte sich das Staatsverständnis im Verlauf der Zeit. Zweitens sind und waren die Verwaltungsforschenden trotz ihrer Ausrichtung an einer nationalen Institution nicht in einem nationalen Diskurs isoliert. In den modernen und zeitgenössischen verwaltungswissenschaftlichen Publikationen wird die internationale Einbettung sowohl in den referierten Werken als auch in den Moden der behandelten Themen und angewandten Methoden evident. Diese Einsicht gilt aber nicht erst ab der Globalisierung in den 1990er Jahren, sondern lässt sich bereits in der Zeit vor der deutschen Staatenbildung aufzeigen. Gerade die Kameralisten reisten häufig zwischen den europäischen Fürstenhäusern umher und sorgten dadurch nicht nur für eine weite Verbreitung ihrer Ansätze, sondern kamen selbstverständlich auch mit fremden Ideen in Kontakt (Wakefield, 2009). Und die Entwicklung in der deutschen Verwaltungswissenschaft nach dem Zweiten Weltkrieg kann ohne eine tiefere Betrachtung der Entwicklungen in den USA nicht verstanden werden. Aus diesem Grund wird hier ein Versuch unternommen, die Entwicklung der deutschen Verwaltungswissenschaft von der Gründung Deutschlands 1871 bis in die 1970er Jahre auf den Einfluss US-amerikanischer Ideen hin zu untersuchen. Dazu werden zuerst in der Sektion I der Untersuchungsgegenstand und die theoretischen Grundlagen eingeführt, anhand derer der Import von Ideen aus den USA durch die deutsche Verwaltungswissenschaft untersucht wird. Sektion II zeigt anhand von Primärquellen die Entwicklung der deutschen Verwaltungswissenschaft. Die Struktur folgt dabei den Phasen sozialer und politischer Umbrüche: Gründung des deutschen Reiches (Kapitel II.1), Zwischenkriegsperiode (Kapitel II.2), Nachkriegszeit (Kapitel II.3) sowie die 1960er und 1970er Jahre (II.4). In Sektion III wird der Ideentransfer analysiert und danach in IV die Konklusionen betreffend die deutsche Tradition der Verwaltungswissenschaft präsentiert.

Segurança Colaborativa: uso das redes sociais para prevenção na segurança do Estado do Rio de Janeiro

Este estudo objetiva compreender como a Polícia Militar do Estado do Rio de Janeiro pode se valer das redes sociais para potencializar a interlocução com a sociedade e aprimorar seu trabalho e gerando valor público. O referencial teórico buscou contextualizar um panorama privilegiado nesse estudo, considerando o ambiente potencializador de interações propiciado pelas redes sociais e a visão da aplicação no campo da segurança. Foram considerados fatores como a evolução da visão sobre o trabalho policial voltado para a área de segurança, evolução esta motivada pela inserção de conceitos voltados para o pleno exercício da cidadania, para a necessidade de colaboração social nas atividades estatais como caminho para atingir as necessidades das pessoas e realização do trabalho dos órgãos estatais, bem como a forma que este envolvimento social tem se dado no contexto recente na Polícia Militar do Estado, analisada a partir de seus exemplos operacionais observados no campo da segurança, a indicação de uma terminologia própria para o momento de envolvimento desses conceitos no campo da segurança, agregando ferramentas e conceitos voltados a Governança Pública e a utilização das redes sociais através do aplicativo WhatsApp, visto ser este aplicativo um dos de maior alcance no contexto nacional e que reúne características próprias ao escopo da pesquisa. Adicionalmente e buscando entender as práticas organizacionais vivenciadas pela utilização das redes sociais através do WhatsApp, foram realizadas entrevistas semiestruturadas com empresas de comunicação e Unidades Policiais com experiência no assunto, o que propiciou um mapeamento das motivações para utilização das redes sociais, suas formas de operação, bem como dificuldades enfrentadas nesta utilização e resultados para os propósitos das organizações. Além dos resultados apresentados neste estudo, as revelações do campo e suas correlações, propiciaram a elaboração de linha mestra para emprego da ferramenta no contexto da Polícia Militar como parte das implicações do estudo. O estudo demonstrou que as redes sociais são úteis como ferramenta para a interlocução social, entre a Polícia Militar e a sociedade, destacando sua capacidade no campo da prevenção e melhoria da capacidade governamental na segurança.

Comunicação mercadológica e apropriações da indústria cultural: Batman e o consumo infantil

Este estudo tem por objetivo analisar o uso do licenciamento do personagem Batman dentro da estratégia de comunicação mercadológica, originada a partir da apropriação do super-herói das histórias em quadrinhos norte-americano de mesmo nome e sua aplicação em itens de consumo voltados ao público infantil (Kids), de 4 a 8 anos, e pré-adolescente (Tweens), de 9 a 13 anos, especificamente. Buscou-se compreender a evolução e popularidade de um super-herói sombrio da cultura de massa, com mais de 70 anos de existência, transformado em marca comercial para produtos infantis, sem qualquer relação aparente com sua caracterização dentro de seu universo simbólico, para um público novo que redescobre o super-herói através de sua divulgação na mídia. O estudo foi desenvolvido através de recuperação bibliográfica dos conceitos abordados, da revisão histórica do personagem, e da pesquisa de campo na forma de entrevistas qualitativas com licenciador e licenciados. Na conclusão, chegou-se às características que indicam as razões da popularidade de Batman, como personagem e marca, bem como os motivos que levam à sua utilização comercial através do licenciamento.(AU)

Auditoria Pública e Privada: Estudo de Caso Comparativo a Nivel da Análise Económico-Financeira e da informação Financeira Prospetiva

A globalização dos mercados e a consequente atuação das empresas a nível internacional, repercutiu-se no processo de harmonização e normalização contabilística do setor empresarial. Tal reforma ainda não ocorreu na Administração Pública, urgindo implementar um corpo de normas, aceite internacionalmente, que sejam transparentes, compreensíveis, fiáveis, consistentes e comparáveis à escala nacional e internacional. A par do sistema contabilístico surge a necessidade, legal ou opcional, de revisão às contas, no sentido de lhes conferir maior credibilidade e, em consequência, apoiar a tomada de decisões económicas por parte de todos os agentes. Neste sentido, quer na esfera empresarial, quer na esfera administrativa, o auditor acaba por assumir uma função de índole social, em virtude da sua atuação na defesa dos interesses coletivos. Na análise económico-financeira também se apresenta relevante para o processo decisório, centrando-se em torno de questões, tais como o equilíbrio financeiro, a rendibilidade dos capitais, o risco e a criação de valor. Embora, numa primeira análise, seja intuitiva a sua aplicabilidade somente ao setor empresarial; em certa medida, esta premissa deixou de se verificar com a New Public Management, orientada pela performance e contenção de custos. Numa era em que as alterações económicas, tecnológicas e sociais são constantes, definir e cumprir uma estratégia, tornou-se num dos objetivos mais importantes para os gestores empresariais, pelo que a contabilidade passou a abraçar uma vertente previsional, capaz de acrescentar valor nesse processo. Reportando-nos à realidade pública administrativa, o cenário de enquadramento difere, devido à sujeição orçamental que lhe é inerente. Neste sentido, esta dissertação tem como objetivo analisar se no âmbito da auditoria realizada quer a uma entidade pública, quer a uma empresa, os objetivos, procedimentos e pressupostos são semelhantes no que respeita à análise económico-financeira e à informação financeira prospetiva.

Managing from the inside out:drawing on 'receptivity' to explain variation in strategy implementation

With the rise of 'New Public Management' (NPM), government policy has encouraged public-sector organizations to downsize and outsource their services. There is, however, local variation in the use of outsourcing - this is 'managing from the inside out'. This paper draws on the notion of receptivity for organizational change to explain variation in strategy implementation. Four receptivity factors are identified which seem to explain the success of two contrasting English local government outsourcing strategies: ideological vision, leading change, institutional politics and implementation capacity. The organization level of change is interconnected with two other levels of change (the public service and environment levels) to illustrate the dynamic nature of change.

Local government modernisation:UK and comparative analysis from an organizational perspective

This article analyses three strands of local government modernization. The first takes an overview of the development of 'modernization' and 'improvement' of local government in the UK under the Labour government since 1997 and the overall programme of reform. We discuss both the shifts and the continuities with the previous decade and a half of the 'new public management' of Conservative administrations. We examine the implicit assumptions about how to achieve organizational and cultural change, arguing that much modernization is premised on a mechanistic metaphor of organizational change. The second section of the article examines other metaphors and theories of organizational change, arguing for the need to consider institutional and organizational perspectives in analysing local government modernization. The third section of the article then applies some organizational concepts to the comparative analysis of local government modernization.

Community pharmacy in a commissioning-led NHS:can pharmacy compete effectively?

Introduction – The commissioning of services has been a core responsibility of English Primary Care Trusts (PCTs) since 2002. Primary care organisations (PCOs) in Scotland, Wales and Northern Ireland have also increased their commissioning activities but with, arguably, less fervour than their English counterparts. The commissioning function of English PCTs has been reinforced by the introduction of new contractual frameworks across primary care – for medical services, dentistry and pharmacy. The new pharmaceutical services contract for England and Wales introduced an “enhanced” category of services, the provision of which is dependent on the commissioning decisions of local PCTs. As the NHS, most pertinently in England, continues its transformation from a provider to a commissioner of healthcare, the ability of pharmacy to compete effectively for funding is likely to become increasingly important. Method - After piloting, in August 2006 a self-completion postal questionnaire was sent to a random sample of practising community pharmacists, stratified for country and sex, within Great Britain (n=1998), with a follow-up to non-responders 4 weeks later. Data were analysed using SPSS (v12.0). A final response rate of 51% (n=1023/1998) was achieved. Within the section of the questionnaire relating to service provision, respondents were asked “do you believe that pharmacy will be able to compete effectively with other healthcare providers for access to additional funding to develop services that address a public health need identified by your local Primary Care Organisation (PCO), e.g. PCT/LHB etc.?”. Answers were recorded on a three-point scale; pharmacy “will”, “may”, or “will not” be able to compete effectively for funding. Results - The attitudes of pharmacists showed variation depending on the type of pharmacy they worked in (supermarket, multiple (outlets (n)=200), large chain (200>n>20), small chain (20=n>5), or independent (n=5)) (?2 test with p=0.001). Over a third of survey pharmacists working in small chains and independents (37% (n=21/57) and 33% (n=113/341) respectively) believed that pharmacy would not be able to compete effectively for funding compared to 23% (n=15/65) for supermarket pharmacists, 22% (n=21/97) for pharmacists employed by large chains and just 18% (n=62/353) for pharmacists employed most regularly in multiples. Furthermore, attitudes also varied between the countries of residence of respondents (?2 test with p<0.05). 27% (n=242/893) of pharmacists resident in England and Wales believed that pharmacy would not be able to compete compared to 16% (n=18/116) of pharmacists resident in Scotland. Conclusions – It would appear that community pharmacists believe that the larger pharmacy chains and supermarkets will occupy an advantageous position in terms of attracting finance to develop services. This could have notable implications for service provision across the sector. If corporate pharmacy chains were to monopolise commissioning monies then the proportion of funding available to independents will be diminished; arguably further hastening their demise, as well as stifling the professional development of pharmacists employed within the independent sector. These findings, when combined with the variation observed between UK pharmacists operating under different contractual frameworks, may be a reflection of the divergent policy in the different administrations with developments in England, including the new pharmacy contract, reflecting a market-based approach with Scotland taking a near opposite stance with service integration and a commitment to new public health. However, it should be acknowledged that the questionnaire did not allow for detection of ambiguities in, or misunderstandings of, the survey question and this should be considered as a limitation of the research.

Project financing 8th edition

The eighth edition is a fundamental and essential update to the seventh edition published in 2000. This new edition examines a comprehensive range of existing and newer topics that are relevant to project financing in 2012 and explores current trends in the project finance and leasing industries. Contributors are experienced academics and practitioners. Since the first edition was published, the financial markets have undergone tremendous upheavals and many new structures and instruments have been created to meet the financing needs of business. This edition considers the wider world of project finance, applicable to such diverse situations as venture capital and leveraged buyouts, and using new approaches such as Islamic finance techniques. The eighth edition is an essential and over-due update to the previous edition published in 2000. The eighth edition updates a comprehensive review of financial and related topics which are relevant to project financing in 2012 and explores current trends in financial modelling of a project, risk management and the private finance initiatives. This is a comprehensive and practical book full of advice and tips for successful project financing, including leasing, offering a clear, easy to understand guide to a complex area with examples. The topic coverage is well organized and complete moving from the fundamentals to the more complex issues. There is an extensive glossary to support readers. Finally the use of 12 practitioner case studies brings many of these complex issues to life. This is the new edition of the clear, easy-to-understand industry-standard text on project financing. With a good overview of a broad area and using principles of project financing to explain complex structures, this book includes lots of examples and case studies (including Eurotunnel, Dabhol, multiple Paiton deals and other recent deals along with subsequent developments) to show the concepts in use, examine outcomes and to ensure you understand important issues such as effective project structuring and financing, financial modelling for project valuation, and risk management. Substantially updated and expanded to provide the latest developments in all aspects of project financing. An important manual reference, this book is a must-have for every project financier's desk. The text unites the domain of project financing with a wealth of project management techniques, supported by diagrams and charts and other pictorial features, where appropriate. All these supporting features facilitate a better understanding of the accompanying text for the reader. In many chapters there are diagrams to clarify the specific transaction structure discussed in the accompanying text. These diagrams enable the reader to get a very clear idea of the transaction structure, which is particularly useful where it is complex or unusual. There are also a number of checklists to assist stakeholders in the project and resource management of complex project financings. The new financial modelling chapters allow exploration of some of the pitfalls project models encounter, challenging the accurate replication of the project cash flows for stakeholders to evaluate. In the later new risk management chapters, worked examples are included to illustrate the techniques in practice. The new public private partnership/private finance initiatives chapter introduces readers to this new approach to public projects. References are made to useful websites throughout the text. Cases are included at the end of the main text to encourage examination of real-life examples of project financing in practice and also highlight specific issues of current interest. The book will be helpful to project finance sponsors, lawyers, host governments, bankers and providers of capital

Discretion and control in education:the teacher as street-level bureaucrat

This article assesses the impact of education reform and the new public management (NPM) on the discretion of school teachers. The focal point of the study is Michael Lipsky's theory of discretion which casts public service professionals and others involved in service delivery as 'street-level bureaucrats' because their high degree of discretionary rule-making power enabled them to effectively make policy as well as implement it. The article considers the relationship between education reform and the NPM and focuses on the increased emphasis on skills-based teaching and changes in management and leadership in schools. The literature and survey of teachers demonstrate that discretion in the workplace has been eroded to such an extent due to a high degree of central regulation and local accountability as to question the applicability of Lipsky's model. The findings are based on the literature and a small survey undertaken by the author. © 2007 BELMAS.

Climate change performance measurement, control and accountability in English local areas

Purpose – This paper aims to consider how climate change performance is measured and accounted for within the performance framework for local authority areas in England adopted in 2008. It critically evaluates the design of two mitigation and one adaptation indicators that are most relevant to climate change. Further, the potential for these performance indicators to contribute to climate change mitigation and adaptation is discussed. Design/methodology/approach – The authors begin by examining the importance of the performance framework and the related Local Area Agreements (LAAs), which were negotiated for all local areas in England between central government and Local Strategic Partnerships (LSPs). This development is located within the broader literature relating to new public management. The potential for this framework to assist in delivering the UK's climate change policy objectives is researched in a two-stage process. First, government publications and all 150 LAAs were analysed to identify the level of priority given to the climate change indicators. Second, interviews were conducted in spring 2009 with civil servants and local authority officials from the English West Midlands who were engaged in negotiating the climate change content of the LAAs. Findings – Nationally, the authors find that 97 per cent of LAAs included at least one climate change indicator as a priority. The indicators themselves, however, are perceived to be problematic – in terms of appropriateness, accuracy and timeliness. In addition, concerns were identified about the level of local control over the drivers of climate change performance and, therefore, a question is raised as to how LSPs can be held accountable for this. On a more positive note, for those concerned about climate change, the authors do find evidence that the inclusion of these indicators within the performance framework has helped to move climate change up the agenda for local authorities and their partners. However, actions by the UK's new coalition government to abolish the national performance framework and substantially reduce public expenditure potentially threaten this advance. Originality/value – This paper offers an insight into a new development for measuring climate change performance at a local level, which is relatively under-researched. It also contributes to knowledge of accountability within a local government setting and provides a reference point for further research into the potential role of local actions to address the issue of climate change.

Accountants as institutional entrepreneurs:changing routines in a telecommunications company

Findings: As part of the consequences of new public management reforms, we illustrate how institutional entrepreneurs de-established an older state-run bureaucratic and engineering-based routine and replaced it with a business- and accounting-based routine. Eventually, new accounting routines were reproduced and taken for granted by telecommunications management and employees. Research Limitations/implications: As this study is limited to a single case study, no generalisation except to theory can be made. There are implications for privatisation of state sector organisations both locally and internationally. Originality/value: The paper makes a contribution to elaborating the role of institutional entrepreneurs as agents of change towards privatisation and how accounting was used as a technology of change. Purpose: The purpose of this paper is to explicate the role of institutional entrepreneurs who use accounting technology to accomplish change within a privatised telecommunications company. Design/methodology: The case study method is adopted. The authors draw on recent extension to institutional theory that gives greater emphasis to agency including concepts such as embeddedness, institutional entrepreneurs and institutional contradiction.

Accounting and the emergence of care pathways in the National Health Service

This paper examines the effects of New Public Management reforms on the information infrastructure underpinning the work of public service professionals. Focussing on the case of the British National Health Service (NHS), the paper argues that hospital accounting reforms played a significant role in the emergence of standardised models of clinical practice. The paper moreover argues that, under the label “care pathways”, such standardised models of clinical practice became embedded in the information infrastructure of the NHS and concludes by discussing their implications for the work of doctors and hospital accountants.