Strategic management accounting practices in hospitals

Purpose - The purpose of this paper is to give an overview of the use of strategic management accounting (SMA) techniques in hospitals under competitive market environments. The paper analyses the dissemination of SMA techniques in consideration of structural characteristics and perform a cluster analysis in order to investigate performance differences between various groups of hospitals. Design/methodology/approach - The paper collected empirical data in a nationwide survey of German general hospitals. Analyses are based on questionnaires from 116 hospitals. Findings - Results show that strategies are applied and regularly adjusted in most hospitals. However, SMA techniques are not in widespread use. The paper explores performance differences between the clusters comprised. The paper finds evidence that the use of SMA techniques varies among hospitals based on their structural characteristics. Research limitations/implications - The authors' exploratory analysis suggest that further study exploring both the determinants and effects of the use of SMA techniques in hospitals represents an interesting path for future research. This study is subject to limitations, particularly concerning the limited number of contextual variables and performance measures taken into consideration. Practical implications - Considering the limited use of SMA techniques, this paper conclude that hospitals should consider the adoption of additional practices. The paper identifies particular potential for development in the areas of risk management and capital budgeting methods. Originality/value - This study provides the first comprehensive overview of SMA techniques used in hospitals and advances the literature, which primarily includes case study evidence on single SMA techniques or analyses of the impact of strategies and health reforms on “conventional” management accounting practices. This paper, then, constitutes a useful starting point for further research on SMA practices in hospitals.