According to de With and Dijkman (2008), "Management control is the process by which managers influence other members of an organization to implement the organization's strategies. This process consists of four different phases-strategic planning, budgeting, measurement and reporting, and evaluation-each of which leads to the next phase" (27). Beyond the foregoing formal phases, management control also includes informal communications and interactions such as meetings and conversations (de With & Dijkman 2008). In a National Health Service setting, though, a control strategy must recognize the need for flexibility throughout the budgeted period of time in ways that might not affect a private sector counterpart. In this regard, Byrne (2006) notes that, "Ideally, the annual budgeting process sets the performance agenda for the year ahead. However, healthcare budgets are often only an estimate of income and expenditure, with incremental budget setting the dominant budget type employed" (67).
Because the management and control of a NHS hospital accident and emergency unit involves a multidisciplinary team of healthcare professionals that play an important role in the budget formulation process, Byrne suggests that innovative budgeting approaches can help provide effective delegation of managerial responsibilities. According to Byrne, "Delegating expenditure consumption up to a certain level can also improve the speed of decision-making if there is no need for authorisation from a higher-level manager. The quality of decisions may also increase given that (better-informed) individuals closer to the point of service delivery can make them" (68). The Beyond Budgeting Round Table advocates budgetary reform that includes the use of "multi-annual, real-time and bottom-up activity-based budgets whereby individual departments (or services) are allocated resources based on evidence-based needs assessment and evaluated and rewarded using a more balanced set of key relative improvement performance measures (for example quality)" (Byrne 2006, 68). Moreover, Byrne cites the tendency for many public sector healthcare organizations to ensure that their entire budget is spent by year-end in order to establish benchmarks for subsequent budget cycles and the need for public sector healthcare organizations to provide additional services with little notice as two factors in particular that make the traditional budget approach inadequate. Byrne suggests that in order to achieve this sea change in budgetary approaches, there is a fundamental need for improved communication between different management levels and the healthcare organisation (Byrne 2008). In this regard, Byrne concludes that, "The latter recognises that rather than the principle of budgeting being at fault, the less-than-optimum application of budgets may have compromised their usefulness to date in the healthcare sector" (68).
The research showed that most organizations use some type of budgeting approach to help them plan and control their activities for a period of time which is typically a year that is divided into increments. Because so much time and effort is invested in the budgeting process, it is important for organizations to realize the maximum return on their investments. The traditional budgeting approach, though, was criticized for being cumbersome, expensive and unwieldy in providing executives and managers with the tools they need to guide their organizations effectively. In response to these charges, alternative budget approaches such as Beyond Budgeting have been introduced in an effort to facilitate the budgeting process in ways that can benefit organizations of all types, including public sector healthcare.
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