The road to uniformity: accounting change in UK voluntary hospitals

This paper explores the development and spread of the uniform system of accounts in United Kingdom voluntary hospitals in the period 1880-1920. The antecedent contextual factors are first established and include the growth of hospital care, changes in its nature, together with the emergence of the concepts of managerialism and efficiency. These factors are identified as important in stimulating the interest of external groups and institutions that were influential in raising the issue of accounting change. However, powerful individuals and groups within the voluntary hospital movement were able to control accounting reform and negate the power of external institutions. thereby successfully excluding the accounting profession from the development of uniform accounts. The paper further examines the subsequent spread of the uniform accounts and finds that economic power and professional and technological forces interacted to achieve a high degree of conformity of accounting practice within voluntary hospitals. This was achieved without the direct intervention of the State. Finally, the paper suggests that hospitals in the US followed the UK with their own uniformity drive.