Project ABC: Unanticipated affinities and affect in hospital health care

Abstract

In this paper, we present an analysis of how activity-based costing (ABC) was included among austerity policy prescriptions within the healthcare sector. Relying on the proposition that an increasing quality of outcomes is achievable simultaneously with a reduction in costs, ABC straddled tensions between the logics of care and business for clinicians but not for administrators. We draw on case study research and use institutional logics and related approaches to analyze how the introduction of ABC became a device that improved communication by clinicians with administrators. When actors’ interests and motivations were aligned, ABC was able to offer professional clinicians value in the hospital in question. The study demonstrates how and why competing logics can coexist where there is ability to affect decision-making.