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The Beatles free essay sample

As I would like to think the best melodic specialists ever to walk the earth. Not exclusively do theyre melodies and music styles bode well, they permit the audience to feel the feelings that they were created to give. The Beatles are generally excellent performers as well as outstanding lyricists. One of the extraordinary melody that they had created as I would like to think is Shes so overwhelming. The motivation behind why I state this is on the grounds that it comes straight out to state that the confidence and any expectation of the US is HEAVY for the U.S patches to carry on there shoulders. It comes straight out to show that the U.S is overwhelming, with all the individuals within it to maintain and to secure. For instance the sculpture of freedom is the thing that speaks to us in a manner and in the method of conveying what speaks to us, it is HEAVY. Hens the she. We will compose a custom article test on The Beatles or on the other hand any comparative subject explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page The Beatles have come to make a lot increasingly incredible tunes, to give some examples, Come Together, Strawberry fields Forever, Sexy Sadie, and Happiness is a warm weapon. To me the Beatles have set an exceptionally high bar for the upset of music. I dont feel that anybody will have the option to over pass the incredible ability, alongside the extraordinary creations of the Beatles. The Beatles were exceptionally canny men when it came to word decision in there music. For instance, in the tune Lucy in the sky with precious stones it says imagine yourself on a pontoon on a stream with tangerine trees and jelly skys those words, those couple of words, toward the start of the melody consequently place me in a quiet universe of unwinding. That is the thing that I search for in music, the manner in which it causes you to feel and whether that feeling is fulfilling. Not exclusively do the Beatles tunes have peppy and glad vibes, they give intense and profound. To close The Beatles wide verity and extream ability make them one of the most outstanding gathering of artists that have ever scrubbed the world for the sake of upset as music. The Beatles free paper test The universe of music has taken a brilliant upswing. On September 9, 2009, The Beatles, one of the most exceptionally acclaimed awesome gatherings ever, discharged their recently carefully restored inventory. This must be depicted as a present for the ears. The entirety of the ageless works of art have been altered, nearly revamped, by the industrys best sound architects, and it appears in the completely clear instrumentals and splendidly adjusted vocals. So what is in reality new about these CDs? To begin with, the sound has been significantly improved with about three many years of innovative advances. Each collection accompanies a booklet highlighting photos of The Beatles, either from the chronicle meetings, or in scenes identified with the tunes. Likewise, on the off chance that you buy the advanced variant, the CD incorporates a little video portraying the chronicle procedure. This index is something fans have been desiring since 1987, when The Beatles collections were erratically moved from their unique vinyl configuration to CD. We will compose a custom paper test on The Beatles or on the other hand any comparative subject explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page Id like to feature the better tracks from different collections. From â€Å"Abbey Road† (1969), â€Å"Come Together† appears to have a general increment in power, and the 16-minute variety is more clear and uncovers a profound and complex guide of sounds  ­unavailable as of not long ago. On â€Å"The White Album† (1968), â€Å"Back in the USSR† and â€Å"Helter Skelter† are escalated, giving the tunes a more full, increasingly complete sound. I suggest buying the remastered index. Indeed, get the whole box set and treat yourself to the melodic impression that solitary this centurys innovation could offer. All the collections make certain to satisfy anybody from the most acclaimed pundit to the easygoing audience.

Why Big Corporation Cannot Be Truly Disruptive

Why Big Corporation Cannot Be Truly Disruptive Disruption is a term often thrown around these days. Companies such as Facebook and Netflix are considered as examples of disruptive businesses and the technology world, especially, is continuously searching for the next disruptive idea. © Shutterstock.com | Barandash KarandashichBut the discussion is mainly centred on start-ups. Does this mean a big corporation cannot be disruptive? This guide will look at 1)  what disruption means, 2) the strategies available for business, and  3) the obstacles ultimately stopping big corporations from being truly disruptive.WHAT DISRUPTION MEANSThe difficulties big corporations face in terms of being disruptive are easier to understand once you define the meaning of a disruptive business. Disruption is constantly mentioned in today’s media, yet few understand the intricacies of disruption.The disruptive business idea was first coined by Clayton Christensen from Harvard Business School. In his book “The Innovator’s Dilemma”, he talked about the theory of disruptive innovation and its possibilities for businesses.In essence, a disruptive business has to transform the industry it operates in. A disruptive business changes the game and challenges the status quo within the in dustry. This can be done by introducing a new product or service for the industry, which has a transformative impact on how other businesses must operate in the field from now on.Therefore, disruptive businesses don’t simply come up with an improved product or service. The idea must always have a deeper impact and it could even create a completely new industry or market.The other terms often mentioned in connection with disruptive business are disruptive innovation and disruptive technology. For example, the difference between innovation and disruptive innovation is again the impact of the idea. A disruptive innovation changes the industry or market, whereas general innovation is mainly about improving an existing product.  Examples of disruptive businessesIt is often easier to understand the distinction between disruptive businesses and other innovative businesses through examples. Below are a few businesses that disrupted their industry.Virgin GalacticIt’s well known Richard B ranson has been a big advocate of disruptive business and one of his businesses has potential to be truly disruptive. His Virgin Galactic created the space for commercial space travel, which could change the way we take our holidays â€" on the moon rather than the Bahamas!While Virgin Galactic has certainly challenged international space agencies such as NASA and created a commercial market for space travel, the technology hasn’t quite developed yet to reach its full potential. But Branson’s space travel business is nonetheless a great example of market disruption.ZapposBut a business doesn’t always have to open up a completely new market in order to disrupt. Zappos is an example of staying in the same market space, but changing the way the industry operates for good.The company’s business idea was all about offering free shipping for customers, both when they receive the product and when they possibly return it. The shoe business was in fact the first to offer this service, which many of us now take for granted.FacebookFinally, you also need to mention Facebook. While monetization and disruption often go hand-in-hand, Facebook was adamant from the start that it wants to remain free. The purpose was to get traffic, not revenue.It was only later, once it had become the largest social media platform on the planet, it utilized advertising as a revenue source. At that moment, it was easy to capitalize on the huge market space it had created by having many users.THE TWO DISRUPTIVE BUSINESS STRATEGIESWhen businesses are looking to disrupt, they often have two clear paths to follow. These two main models were laid out also by Christensen in his book.The two disruptive business strategies are:New market disruption â€" This kind of disruption takes place when a product or service enters an existing category that has previously not created consumption. Therefore, the product or service will offer customers something, which doesn’t yet exist in the market, alth ough the industry is already there. Customers who previously were not able to use the products or services in the market will now be able to do so because of the disruptive business. The product or service they offer could be available due to a variety of reasons, such as cheaper price, better availability, enhanced usability and so on. The examples of businesses that have disrupted in this manner could include Virgin Galactic and Ryanair, for example. Both opened up an existing market for more customers, Virgin by offering the option of space travel to other than the scientific community and Ryanair by dropping air travel prices to those of trains and bus routes.Low end disruption â€" The other strategy occurs when the business competes for the bottom of an existing market by dropping prices. The product or service is aimed directly for customers who want the cheapest products or services from the industry. This kind of disruption occurs when the industry offers mainly products or services that the market wants, but with prices, the market is not necessarily prepared to pay. It can also be characterized by the market over-supplying the customers’ needs. In a way, Ryanair could also offer an example of this, as the company stripped services away to drop prices. It bet on the idea that customers might not require a free meal during flight, for example. On the other hand, Zappos is another example, as they offered exactly the same products but dropped the price of getting it by removing delivery fees. Another disruptive business example is the digital camera business Flip. The cheap digital camera didn’t have the same technical qualities that professional cameras did, but the market nonetheless loved it. Later, the company itself was disrupted by the rise of the smartphone with their in-built digital cameras.It is important to note that while businesses can use cheaper price as part of their disruptive strategy, low price alone is not enough to disrupt. Rath er, disruptive businesses must use technological or business model advantages for their benefit and to scale the existing products or services for the new market.If the business just cuts cost to offer a product or a service without offering the similar service, the business is not disrupting the market. As mentioned above, the new product or service has to change the way the market operates or the market size in order to be disruptive.Take the example of the hotel industry. A cheaper hotel won’t be disruptive, unless it can offer the same luxuries as the pricier hotels, but with lower costs. On the other hand, it could disrupt the market by opening it up to a completely new customer base.BUT IS THERE A THIRD ALTERNATIVE?As you’ll see in the next section, the above two models can be difficult to achieve if the business is already established. But there could be a third strategy, which might offer more opportunities for larger corporations.This is the cross-boundary disruptive bu siness strategy. Former Inter CEO, Andy Grove, has argued that businesses can be disruptive also by getting involved with an entirely different industry. Since only an established business, can grow its operations beyond its initial industry, this strategy is only suitable for big corporations.According to Grove and his research partner professor Robert Burgelman, there are certain conditions under which “a firm can create a new growth spur for itself by entering an entirely different industry”. The conditions for the disruption require:The new industry to be stagnant, where innovation by existing companies is nearly non-existentThe new product or service has to shake up the industry, in a similar manner to typical market disruptionThe perfect example of this kind of strategy would be Apple. The company, which was known for its desktop computers and laptops, entered a completely new market with its iPhone.The company’s venture into the industry accomplished both requirements f or a big corporation disruption. It found an industry, which had become rather stagnant, as mobile phone makers were only slightly improving existing phone models.It also didn’t just create a phone for the sector, but changed the status quo and the way manufacturers developed phones. While smartphones had certainly existed before the iPhone, Apple offered a better customer experience with its invention of apps as well as the use of technology.PROBLEMS BIG CORPORATIONS FACE WITH DISRUPTIONWhen it comes to innovation, most of the conversation is dominated by start-ups. If you look at the biggest disruptive businesses in any industry, the clear majority of them achieved disruption as a start-up. While Facebook is now a huge corporation, it didn’t disrupt the market as an established business. The examples, such as Apple, are much harder to find.But what are the obstacles big corporations face that limit their chances of disruption? The below highlights the problems larger companies are faced with.Innovation flourishes in the start-up mentalityA start-up business is essentially built on the idea of innovation. Because the business is entering a market that is already there, the business must create a fresh idea before it can begin operating. This means start-up companies are driven by the passion to change the market.On the other hand, innovation isn’t at the heart of a big corporation, as they have already made it, so to speak. The company has achieved a market share and its focus isn’t directed at creating new ideas, but rather making sure its existing ones are up to date.Start-ups are also built around this single idea and since the business is not established, it can focus all of its energy in developing the idea. It has the ability to place all of its efforts in streamlining the idea, whilst a big corporation has to also focus on its day-to-day operations.The innovative mentality is also enhanced in start-ups by the kind of staff it has. Start-ups are looking for innovations, risk-taking and people, who aren’t after the money. Since you can’t guarantee the business will hit off, the people building the business won’t be motivated by money in the same way as people working for a big corporation.For big corporations, the key is to find qualified people who know what they are doing. This typically means focusing on finding the doers and not necessarily the innovators.Innovative disruption is all about changing the business modelThe other problem is to do with the differences in the business model between big corporations and start-ups. As the definition of innovation shows, the whole process is about changing the existing business models in the market, so that the status quo of the industry changes.A start-up is starting from a point where it has an idea for a product or service and it needs to find a workable business model to execute this idea. It is starting from nothing and creating the business model to disrupt as it goe s along.In contrast, an established business is required to implement its established business model. This is required because it guarantees the business operates efficiently and its customers remain satisfied. With an existing customer base, not to mention shareholders expecting a return, the business cannot start tweaking its business model too much in order to disrupt.For example, a start-up looking at new market disruption strategy would come up with a product or service that caters for a new market within an established industry. Since it doesn’t have an existing customer base, it is focused solely on creating one. But a big corporation could end up alienating its existing customers by targeting a new market.If your customers love the product and the service, it’s quite a big risk to completely change this concept and continue to attract the same customer base. Not to mention its potential impact on the brand image. Customers could easily feel let down if the business tries to change its business model completely.The problem of bureaucracy and risk-takingMuch of the above problems also boil down to big companies’ limitations to take risks. For example, finding a viable business model for disruption will require risk taking and it is inherently a risky thing to do. A big corporation could end up blowing a lot of money into an idea that won’t even work. A start-up has much less to lose in business terms from a failed idea.Disrupting an industry is not easy and changing the status quo can be, if not impossible, then at least extremely difficult. The willingness to take risks naturally falls if you already have something good going for you. The stakes are higher for big businesses and big part of it is the fact they aren’t simply accountable for themselves.The owners of a big corporation cannot take big risks without the approval of the board and the shareholders. But these are often more focused on maintaining the status quo and ensuring the profit keeps flowing in. On the other hand, a start-up is typically a small group of people who won’t necessarily miss a lot, as the business is not generating any revenue in the first place.This is not only a question of risk-taking, but of bureaucracy as well. A big corporation has to go through a lot more paperwork and discussions in order to start innovating and changing its business model, whereas a start-up can skip these.More focused on optimization rather than disruptionWhile big corporations might not be able to be truly disruptive, it doesn’t mean they cannot be innovative. In fact, for any company to survive it will have to develop its products and services to keep customers happy. After all, big corporations must ensure a disruptive start-up doesn’t completely put them out of business.But the difference here is that big corporations tend to be more focused on optimization rather than disruption. They are looking for ways to maximise the market share by innovating, not by disrupting the industry.For example, a big business will have an advantage of being able to access larger datasets. Analyzing the information about their customers can create better opportunities for understanding what customers want. With the help of this information, the big corporations can develop and improve existing, as well as new, products or services. Therefore, they can optimize their business model to fit market needs, some of which might not have been as obvious without the data analysis.Nevertheless, for big businesses, disruptive innovation can be nearly impossible since the definition of disruptive innovation requires the challenging of the status quo. Since the business is already part of this status quo, it cannot truly be disruptive. It can, of course, innovate and optimize the market share it enjoys.THE BOTTOM LINEWhile big corporations enjoy certain advantages, such as access to better resources and customer data, their ability to disrupt is still limited. Big c orporations aren’t best suited for fostering new ideas because their business model, culture, and risk-taking ability is hindering their innovative capabilities.If you take the strict definition of disruption, which often requires the changing of the status quo, big corporations are nearly incapable of truly disrupting a market, which they are already part of â€" you cannot disrupt yourself.But as the above has shown, big corporations might be able to disrupt if they look into cross-boundary disruption, as well as by creating partnerships with other companies in the industry. This could offer them a better chance of creating a lasting impact and changing the rules of the game.

Similarities Between Charlotte Brontes Life and Jane...

ABSTRACT This study mainly concerns with the similarities between Jane Eyre and Charlotte Bronte’s life. The aim is to find out how Charlotte Bronte’s life and experiences affect Jane Eyre. The most frequently and the most effective similarities from the earlier parts of their lives to the end of their lives are given in this study. It is also aimed to determine the frequency of similarities and effectiveness of these similarities by analyzing their lives. After analyzing the collected data, the findings of the analysis show that there are many similarities in each part of their lives. The similarities in their childhood are the most effective ones. It can be easily concluded that Jane Eyre is based on the life of Charlotte†¦show more content†¦Significance of the study Jane Eyre by Charlotte Bronte is one of the most important works in English Literature. Jane Eyre’s life in the book has attracted the attention of people for many years. Her interesting life of Jane Eyre is reflected to her creator’s life. In this research, the researchers are going to find the answer of how Charlotte Bronte affects her character and which similarities are seen between them. Bronte creates a life in Jane Eyre to narrate her own life. This research is going to enlighten the people especially their similarities. Therefore, the analyzing of their lives is going to be beneficial for those who deal with English Language and Literature. What is more, it is going to be useful for ordinary people who are interested in literature. In the light of this research, understanding of the lives of Jane Eyre and Charlotte Bronte is going to be more effective and enjoyable. Literature Review The life and characteristics of Bronte affect her work, Jane Eyre. There have been many different perspectives associated with this topic until now. In Charlotte Brontà « and the Mysteries of Love: Myth and Allegory in Jane Eyre, Elizabeth Imlay mentions this reality; â€Å" Because so much is known Charlotte Bronte’s history, it is easy to fix on resemblances between her life and

School Uniforms And Its Effect On Self Image - 1548 Words

Most commonly found in private schools, school uniforms are slowly being adopted by public schools in the US. In the 2003-2004 school year every one in eight schools required uniforms; in the 2011-2012 school year that number had increased to every one in five schools (ProCon.org). As violence increased, schools started enforcing uniforms thinking that it would solve the violence. School uniforms were created in England in the 16th century for students referred to as the â€Å"charity children† (ProCon.org). In later centuries, high-class schools were the most commonly known for requiring their students to wear uniforms. The first recorded time a public school in the US required uniforms was in 1987, a school in Maryland put out an optional uniform policy (ProCon.org). Uniforms have been being enforced by private schools for years, but now public schools are trying to enforce them. Students should not be required to wear uniforms because it refuses students the ability to expr ess themselves, dress codes are more effective, and uniforms can cause a detrimental effect on self-image. High school is a vital time in a child’s life to discover who they are as an individual; expressing themselves through clothes is part of this process. If a student is required to wear a uniform everyday, that would create a lack of self expression. The First Amendment states that every human being in the United States is entitled to express themselves (Anderson). When students are forced to wearShow MoreRelatedPros And Cons Of School Uniforms1158 Words   |  5 PagesSchool Uniforms: Are Boomers and Stickers Affecting the Way People See Them? People say that school uniforms are a good thing. They prevent bullying, they are easier for parents to dress younger students, and they help students focus on studying, not what they are wearing. Are school administrators or boomers of the American school systems causing students to become Wendys Berrys version of stickers? Having students wear school uniforms have several pros and cons to them, including the costRead MoreThe Importance Of School Uniforms In Schools1693 Words   |  7 Pagesprivate and public schools around America have a uniform policy. The idea of bringing uniforms to schools is an issue that has been discussed and argued about for many years. There are very few students who believe that uniforms should be required, and other students just dislike the colors that come with them. Although uniforms have been known to make students look decent, there are many negative side effects that come with them. Some people think that a student wearing a uniform looks well and respectableRead MoreThe Need to Enforce Uniforms in Our Schools1128 Words   |  5 Pagesgirls walking into different schools on their first day. One girl is wearing a t-shirt, jeans, and sneakers with no name brands. As she walks in her classroom she immediately feels out of place because she surrounded by her peers wearing the most expensive name brands she has ever seen. The second girl walks into school wearing Abercrombie jeans, a Lilly Pulitzer top, and Sperry’s that makes her feel popular because of her clothing. The last girl walks into her school wearing a khaki skirt and a purpleRead MoreSchool Uniforms And Schools Uniforms1211 Words   |  5 PagesSchool uniforms began their revolution in private schools; they represented a unique appearance, and provided a safe environment for the students attending. Private and Catholic schools were clever enough for implementing school uniforms, because without their influence public schools would have not adapted on creating a dress code for students. By introducing school uniforms in school policies they have managed to impact students learning environment in reducing stress, changing students’ behaviorRead MoreEffectiveness And Use Of School Uniforms1140 Words   |  5 PagesEffectiveness And Use of Uniform in Schools Nyi Nyi A. Myin Wingate University  The Effectiveness And Use of Uniform in Schools The discussion regarding the purpose of schools uniforms among parents and school administrators have increased in the last few years. The debate on whether school uniforms affect students’ performance have challenged also. School uniforms are often seen as unstylish and unattractive due to lack of design and color scheme. The use of school uniforms are used to aid students’Read MoreSchool Uniforms Should Be Public Schools968 Words   |  4 Pages School Uniforms Parents around the globe have emphasized the controversy over school uniforms. During the school year of 2011-2012, one in every five school required students to wear school uniforms. America s first documented schools to inaugurate uniforms were in Maryland and Washington. Throughout the previous years in America, there have been numerous disputes whether school uniforms should be in public schools. In the last 30 years, public schools have often been hostilely compared to privateRead MoreThe Issue Of Mandatory School Uniforms953 Words   |  4 PagesThe issue of mandatory school uniforms is one that has gained a lot of traction in the recent years. As you could imagine proponents of school uniforms will say that it increases graduation rates and decreases school violence. Opponents of it will say that it restricts freedom of expression, and is way to further restrict students’ rights. In a world where we are continually being restricted on our rights the positives of mandat ory uniforms does not outweigh the negatives, because restricted kids’Read MoreSchool Uniforms : A Veil Of Creativity1615 Words   |  7 PagesEnglish III Honors 12 November 2015 School Uniforms : A Veil of Creativity Although the uniform requirement has just been recently imposed, uniforms have been in existence for several centuries now. The first documented usage of a ‘standard’ garment in education was in 1222, where students were required to wear a â€Å"cappa clausa† or a robe-like outfit. School uniforms make schools a less happier place. School uniforms restricts self expression. Having required uniforms in a school’s curriculum negativelyRead MoreDo School Uniform Have An Effect On Students Academic Achievement?1273 Words   |  6 PagesIntroduction: Research question: Do school uniform have an effect on students academic achievement ? - What do school uniforms mean to students? -What are the pros and cons of having school uniform? - What is the effect it has on students? This research starts with the hypothesis: there is no relationship between uniform and student academic achievement. This main research topic is divided into three subtopics above to address the main question gradually. The aim for conducting this researchRead MoreThe Bright Side Of School Uniforms. Education In The United1597 Words   |  7 PagesSide of School Uniforms Education in the United States from Kindergarten all the way to 12th grade is known for its free education system. That’s right, students all over the country are given the opportunity to retrieve a high school diploma for free. 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Budgeting Practices and Performance in Small Healthcare Businesses Free Essays

string(115) " adoption of budgets and the extent of their use for our sample of small Australian primary healthcare businesses\." Management Accounting Research 21 (2010) 40–55 Contents lists available at ScienceDirect Management Accounting Research journal homepage: www. elsevier. com/locate/mar Budgeting practices and performance in small healthcare businesses Robyn King a , Peter M. We will write a custom essay sample on Budgeting Practices and Performance in Small Healthcare Businesses or any similar topic only for you Order Now Clarkson a,b,? , Sandra Wallace c a b c UQ Business School, The University of Queensland, Brisbane 4072, Australia Faculty of Business Administration, Simon Fraser University, Burnaby, Canada V5A 1S6 Department of Accounting and BIS, The University of Melbourne, Victoria 3010, Australia a r t i c l e i n f o a b s t r a c t We present evidence linking primary healthcare business characteristics, budgeting practices, and business performance. Based on a sample of 144 responses from a survey of members of the Australian Association of Practice Managers (AAPM), we ? nd that factors identi? ed by contingency-based research are useful for predicting a business’s budgeting practices. Speci? cally, we ? nd the adoption of written budgets to be related to size and structure, and for businesses using written budgets, the extent of use is related to business structure, strategy and perceived environmental uncertainty. Finally, we ? nd evidence of a relationship between budgeting practice and performance. Here, we initially ? nd a business’s performance to be positively associated with the use of written budgets. More re? ned tests of the â€Å"? t† between business contingency factors and extent of operating budget use then provide evidence of a positive association between the extent of â€Å"? t† and performance. Crown Copyright  © 2009 Published by Elsevier Ltd. All rights reserved. Keywords: Budgeting SME Healthcare businesses . Introduction This study investigates the relationship between contextual factors identi? ed from contingency-based research, the adoption and extent of use of budgets, and business performance within the Australian primary healthcare setting. 1 We focus on budgets because they are considered to be one of the main management control systems This study is based largely on Robyn King’s Honours thesis completed in the UQ Business School at the University of Queensland. The authors would like to thank the editor and the two anonymous referees, as well as workshop participants at Monash and Swinburne Universities, the 2007 AFAANZ Annual Conference, and especially Aldonio Ferreira, Axel Schultz, Shannon Anderson and Julie Walker for comments on an earlier version of the manuscript. ? Corresponding author at: UQ Business School, The University of Queensland, Brisbane 4072, Australia. Tel. : +61 7 3346 8015; fax: +61 7 3365 6788. E-mail address: P. Clarkson@business. uq. edu. au (P. M. Clarkson). Primary healthcare is the initial care of a patient as an outpatient excluding diagnostic testing; tertiary healthcare is that provided in a hospital setting. (MCS) in organisations, have been found to be the earliest MCS that a business adopts, and continue to receive signi? cant attention in the research literature and in teaching material (e. g. , Davila and Foster, 2005, 2007; Sandino, 2007). We select the Australian primary healthcare sector as our experim ental setting both because of its importance socially and economically, and because it is likely to be comprised of businesses that vary broadly in their budgeting practices. Contingency-based research proposes that there is no single MCS suitable for all businesses. Instead, the suitability of a particular MCS is argued to be contingent upon characteristics of a business including its size, strategy, structure, and also management’s perceptions of the uncertainty of the environment within which the business operates. We begin by examining the relationship between a business’s budgeting practices and these four contextual factors. In so doing, we view the development of a budgeting practice as consisting of two stages, the initial decision regarding adoption and the subsequent decision regarding extent of use. Here, the term ‘adoption’ re? ects the decision by a business to use a formal process to project its future 1044-5005/$ – see front matter. Crown Copyright  © 2009 Published by Elsevier Ltd. All rights reserved. doi:10. 1016/j. mar. 2009. 11. 002 R. King et al. / Management Accounting Research 21 (2010) 40–55 41 ?nancial performance (Davila and Foster, 2005). Alternatively, the term ‘extent of use’ refers to both the number of different types of budgets the business uses and the frequency of their use. In our analysis, we develop arguments for, and investigate, these two stages separately. We then turn to consider the relationship between a business’s budgeting practice and its performance. The relative â€Å"? t† of the business’s MCS with its contingency factors is argued to impact on performance, with performance increasing with the degree of â€Å"? t† (Chenhall, 2003). Thus, ceterus paribus, businesses using a practice which does not â€Å"? t†, whether by â€Å"over-budgeting† or â€Å"under-budgeting†, are expected to experience weaker performance. We argue that not all of our sample businesses are likely to exhibit â€Å"best budgeting practice† because of the dif? ulties associated with identifying and implementing best practice, and the discontinuous nature of upgrades (Luft, 1997). We examine the relation between â€Å"? t† and performance using the method proposed by Ittner and Larcker (2001) and classi? ed as a Cartesian/Contingency approach (Gerdin and Greve, 2004). Degree of â€Å"? t† is measured as the difference between the extent of budget use and that predicted by the business’s contingency factors. This approach assumes that at any point, not all businesses will in fact have implemented their optimal practice. To conduct our investigation, a written survey of 988 members of the Australian Association of Practice Managers (AAPM) was undertaken. In brief, we ? nd that larger, more decentralised healthcare businesses are more likely to adopt written budgets. Further, for the subset of businesses that use written budgets, we ? nd that the extent of budget use is positively associated with structure (decentralisation) and strategy (cost leadership), and negatively associated with perceived environmental uncertainty (dynamism). Finally, we document a relationship between choice of budgeting practice and performance. Here, we initially ? nd performance to be positively associated with the use of written budgets. More re? ned tests then provide evidence of a positive association between the degree of â€Å"? t† and performance. Our study makes several contributions. First, we present evidence that contingency factors do indeed provide insights into both the adoption of budgets and the extent of their use for our sample of small Australian primary healthcare businesses. You read "Budgeting Practices and Performance in Small Healthcare Businesses" in category "Papers" Interestingly, the results suggest that size and structure capture the business’s initial decision to adopt a formal budgeting practice. However, once a business has adopted a formal practice, strategy, structure, and perceived environmental uncertainty appear to be the primary determinants underlying the subsequent decision regarding the extent of budget use. We also present evidence that the â€Å"? t† of our sample business’s budgeting practices is associated with performance. To our knowledge, there has been relatively little empirical evidence on this relationship documented in the literature to date. Second, contingency-based research has predominantly been conducted in the large business sector. We extend this work by examining a small business setting. We argue that our setting has the advantage of allowing for an examination not only of the extent of budget use but also of the initial decision to adopt a budgeting practice. In con- junction, it also provides an opportunity to examine more closely the different underlying theoretical constructs of size that the two most commonly used proxies, gross fees and full-time equivalent employees, may be capturing. Finally, from a practical perspective the healthcare sector is under continuing pressure to increase its ef? iency. This study contributes by examining the contexts in which the use of budgets is associated with enhanced performance in primary healthcare. The results should be of bene? t to both practitioners and those who advise practitioners on MCS design. The remainder of this paper is structured as follows: Section 2 presents background material; Section 3 describes our experimental setting; Section 4 presents the hyp otheses, Section 5 the method and Section 6 the results; and Section 7 provides a summary and conclusions. 2. Background MCS have been de? ed as all devices and systems that businesses use â€Å"to ensure that the behaviours and decisions of their employees are consistent with the organisation’s objectives and strategies† (Malmi and Brown, 2008). We focus on a business’s decision regarding its budgeting practices. Budgets are considered an MCS because they can in? uence the behaviours and decisions of employees by translating a business’s objectives into plans for action, communicating the objectives, and providing a benchmark against which to assess performance. We view budgets as both an important and appropriate focus given that they are considered to be one of the main MCS in organisations, have been found to be the earliest system adopted in startup businesses, and continue to receive signi? cant attention in the research literature and in teaching material (Davila and Foster, 2005, 2007; Sandino, 2007). Within the MCS literature, the term ‘budgeting’ is used to refer to a broad range of topics (see Chapman et al. (2007) for a review). In this study, we de? e a budget as a forward looking set of numbers which projects the future ? nancial performance of a business, and which is useful for evaluating the ? nancial viability of the business’s chosen strategy or deciding whether changes to the overall plan are required (Davila and Foster, 2005). Budgets have been identi? ed as playing a number of roles which include making goals explicit, coding learning, facilitating co-ordination, promoting accountability, facilitating control, and contracting with external parties (Davila et al. 2009). Bene? ts of budgeting include increasing ef? ciency through planning and co-ordination, supporting both control and learning through the comparison of actual results with plans, and more globally â€Å"the ability to weave together all the disparate threads of an organisation into a comprehensive plan that serves many purposes† (Hansen and Otley, 2003). Given these various roles and potential bene? ts, one might expect all businesses to adopt a formal budgeting practice. In fact, this view appears to underlie much of the empirical MCS research predominantly conducted in a large business setting, as it is often assumed that large businesses will already have formal MCS that can be readily examined (Chenhall, 2003). Here, the focus has typically 42 R. King et al. / Management Accounting Research 21 (2010) 40–55 been on the adoption and performance implications of speci? c MCS â€Å"innovations† like activity based costing (ABC) (Ittner et al. , 2002). However, it is argued in the MCS literature that a rational adoption decision should require an evaluation of the associated costs as well as the bene? s (Davila and Foster, 2005). Costs of a formal MCS include the easily measured out of pocket costs associated with implementing and operating the system (Hansen and Otley, 2003; Hansen and Van der Stede, 2004). Other costs that are not so easily measured are the possibility that budgets create rigidity thereby limiting co-operation and creati ve response, over-emphasise short-term cost control and top down authority, encourage gaming, and de-motivate employees (Hansen and Otley, 2003; Hansen and Van der Stede, 2004). Further, arguably the bene? s and costs associated with adopting a formal budgeting practice will not be the same for every business but will depend on business-speci? c contextual factors. Thus, ex ante, it is not clear that adoption of a formal budgeting practice is necessarily a rational outcome for all businesses. Our study distinguishes itself from the majority of the MCS literature by focusing on the small business setting, speci? cally the primary healthcare business sector. Within this sector, we argue that it is likely that for some businesses, the costs of budgeting will outweigh the perceived bene? s whereas the converse will likely be true for others. Thus, we argue that this setting provides the opportunity to gain insights into both the decision regarding the adoption of budgets as well as the subsequent decision regarding the extent of their use. We investigate the contextual factors that delineate the costs and bene? ts associated with budgeting from a contingency framework perspective. Our initial focus is on the contextual factors that differentiate adopters from non-adopters. We then consider those factors that drive the decision regarding the extent of budget use and conclude with an investigation into the relationship between the ? t of a business’s budgeting practice with its contextual factors and its performance. In adopting a contingency framework perspective, we acknowledge that research referring to contingency theory has been subject to the criticism that contingency is a general idea rather than a theory as â€Å"there is no a priori intuition of its own as to what the pertinent factors are and as to their likely consequences† (Spekle, 2001). In this study, we do not consider contingency as a theory but rather as a framework for investigating identi? ed factors for which we have a priori intuition based on other organisational, economic and sociological theories. A further criticism of the contingency-based literature is its simplistic nature of investigating one contextual factor or MCS at a time (Fisher, 1995). In the face of this criticism, some studies have begun investigating multiple contextual variables simultaneously (Hansen and Van der Stede, 2004; Cadez and Guilding, 2008). We also consider multiple contextual factors, speci? cally those identi? ed in Chenhall’s (2003) review of the MCS literature since 1980. This review con? rms environment, technology,3 structure and size as â€Å"the descriptors of the fundamental generic elements of context†. Strategy is also included as it emerged in the 1980s as an important factor that in? uences the design of MCS (Lang? eld-Smith, 1997). Finally, contingenc y-based research has its roots in sociology. The underlying premise of sociology is that humans are boundedly rational and satis? cing (March and Simon, 1958). Bounded rationality can impede decision-making as not all possible alternatives are known with certainty at a given point in time. One identi? ed role of MCS is to assist managers in decision-making (Lawrence and Lorsch, 1967). However, the decision on the optimal MCS is itself restricted by bounded rationality, as well as the personal incentives of the manager. Thus, while conceptually organisations may be expected to use the optimal MCS, this is not always possible. Businesses facing the same contextual factors may therefore choose different MCS, with the differences re? cted in their performance. In our study, we investigate the effect of a mismatch between the contextual variables and the extent of use of budgets on performance. 3. Experimental setting We adopt the Australian primary healthcare sector as our experimental setting for two reasons. First, we view it as an inherently interesting research setting in its own right, given its importance both socially and economically. S econd, we believe it to be an ideal setting within which to conduct an investigation into budgeting because as argued below, it is a sector within which there are likely both signi? ant incentives and disincentives to budget. Thus, this setting provides the advantages of the controls that arise from working within a single industry while at the same time, one within which variation in budget use can reasonably be expected. 4 In detail, the Australian primary healthcare sector plays a uniquely important role in terms of both the services it provides and its place in the economy. In terms of services, it represents the gateway through which patients most typically enter the health system. Initial contact with For a sample of 57 organisational units, all with budgeting practices in place, Hansen and Van der Stede (2004) undertook an exploratory study focusing on four contextual factors (strategy, structure, environment, and size) as possible antecedents to identi? ed reasons to budget. Alternatively, for a sample of large businesses, mostly manufacturing from Slovenia, Cadez and Guilding (2008) ? nd that superior performance results from an appropriate match between the contingent factors strategy, size, and market orientation, and strategic management accounting applications. We initially considered technology as an additional contextual variable but decided against its inclusion given our choice of experimental setting. Recent advances in medical technology have impacted on diagnostic specialties such as pathology and radiology (specialties not included in our study) to a much greater degree than primary healthcare. With the exception of three opthalmologists, the only specialists included in the survey were those that provide outpatient services from private rooms and like GP’s, still largely rely on their skill and basic instruments such as the stethoscope. From an administrative and medical records perspective, the use of technology is widespread, with computers being used in 89. 8% of all GP practices and 94. 5% of all specialist practices in 2002 (ABS, 2002). 4 In this regard, Merchant (1981) suggested that a desirable extension of budgeting studies guided by contingency frameworks would be to collect data from samples chosen to magnify the variation on the dimensions of interest while controlling for the many possible interacting factors which obscure or distort the ? ndings. R. King et al. Management Accounting Research 21 (2010) 40–55 43 the health system is through a general medical practitioner (GP). For specialised care, patients are then referred to specialist medical practitioners. GPs and specialists provide this primary care from private consulting rooms and refer on to other providers for diagnostic tests. 5 Economically, the sector contributed 1. 71% of GDP in 2007 (AIHW, 2008). 6 Faced with rising costs, doctor sh ortages and increasing waiting times, primary healthcare businesses are increasingly under pressure to become more ef? ient (Department of Health and Ageing, 2005). Here, budgeting has been identi? ed as a management accounting tool that enhances ? nancial performance and improves ef? ciency (Davila and Foster, 2007). Further, the majority of the existing management accounting research has been focussed on in-hospital care so little is known about MCS in the outpatient setting (Abernethy et al. , 2007), with the exception of a recent U. S. -based study of the relation between performance-based compensation and ownership of primary healthcare businesses (Ittner et al. 2007). Taken together, these facts reinforce our view that the primary healthcare sector within Australia is an important and potentially fruitful setting for the conduct of MCS research generally, and research into budgeting practices more narrowly. More directly to the current investigation, we seek an experimental se tting with variation in budget use, including the presence of both adopters and non-adopters. We believe that a number of factors conspire to make the primary healthcare sector a reasonable choice, ex ante. First, the small business sector has been argued to have lower levels of formal planning and control (Chenhall and Lang? eld-Smith, 1998). As such, it might also be expected to include non-adopters. 7 In Australia, primary healthcare is largely provided by private businesses owned by the doctors working in the business as sole traders, in partnership, or through a company. Management of these businesses has traditionally been by the owner, although there now appears to be a trend towards the delegation of management to practice managers. 8 These primary healthcare businesses typically have fewer than 50 employees and would thereby most often be classi? ed as small businesses according to the OECD de? nition (Holmes and Kelly, 1989). 9 Second, prior research also ? nds that rapid growth small-to-medium enterprises (SME) provide more extensive future-oriented ? nancial reporting than matched non-growth concerns (McMahon, 2001). Arguably, small primary healthcare businesses are less likely to be rapidly growing as there is currently an undersupply of primary healthcare workers due to an ageing workforce and restrictions on training places. 0 These limited organic growth prospects further our expectations of ? nding non-adopters. Third, ? rms within the service sector typically do not need to account for stock, thereby eliminating one driving force behind the use of sophisticated MCS. Finally, research on small and family business supports the view that necessary management skills are required before planning can be initia ted (Gibb and Scott, 1985). Since there is a lower likelihood that primary healthcare owners, the majority of whom are doctors, have formal training in MCS, non-adoption is even more likely relative to other service sectors. Conversely, there are also economic incentives to adopt budgets. As noted, primary healthcare businesses are under increasing pressure to become more ef? cient. The National Health Performance Committee has adopted a framework speci? cally designed for measuring healthcare system performance, with one of the identi? ed components being ef? ciency. In response, a number of institutions and private management consultants now offer education on managing primary healthcare practices that includes training on budgeting. 1 In conjunction, there is the added incentive to undertake these education programs in that continuing education is a requirement of the accreditation process for GP practices. Further, only accredited practices can access Practice Incentive Payments (PIP) from the Federal Government which can represent signi? cant additional revenue. 12 5 There is currently no Medicare funding for diagnostic services provided within the primary healthcare setting and so, these businesses do not invest in the associated technology. The specialist practices included in the study were the private rooms of orthopaedic surgeons, opthalmologists, ermatologists, gynaecologists, and gastroenterologists. These specialists conduct initial consultation and post operative follow up from their private rooms but perform procedures in hospitals or day surgeries for which they have visitation rights, using equipment supplied by the hospital/day surgery where a fee is charged directly to the patient for its use. 6 Overall, the healthcare industry contributed 8. 98% of GDP in 2006–2007, with 19% of recurrent health expenditure on medical services provided by GP’s and specialists. In 2006–2007, Medicare paid $4029. million for GP services, representing an average 4. 93 items per capita (AIHW, 2008). 7 In contrast, international studies of formal budget use have focused on large businesses, ? nding the vast majority use annual ? xed budgets (Horngren et al. , 2006 ). Australian evidence is consistent, with 97% of large businesses found to use budgets (Chenhall and Lang? eld-Smith, 1998). 8 The exact extent to which management is being delegated to practice managers is uncertain given a lack of studies into the prevalence or role of practice managers (Department of Health and Ageing, 2005). There were 9600 private GP practices operating in Australia at the end of June 2002. Of these, 68. 5% were single practitioner practices employing 2. 9 persons on average, and only 100 employed more than 10 practitioners. At the same time, there were 9864 private specialist practices, 89. 7% of which were solo specialist practices employing an average 3. 2 persons and only 19. 2% had greater than 10 practitioners (ABS, 2002). 10 There has been a recognised unfavourable long-term trend since 1999 towards an increasing percentage of primary care practitioners aged 55 years or over. In conjunction, the World Health Organisation (WHO) predicts a global workforce shortage of 4. 25 million health workers over the next decade (Cresswell, 2007). 11 The 2008–2009 Federal Government Budget proposal includes administered Program 5. 3—‘Primary Care Policy, Innovation and Research’ which among other things, â€Å"funds initiatives to improve service delivery and help GPs access current best business practice. † As a part of their response, the Australian Medical Association (AMA) and the AAPM have made available speci? cally tailored business education programs for healthcare managers. 2 The Royal Australian College of General Practitioners (RACGP) standards for general practice include: â€Å"Our administrative staff can describe (and there is evidence of) training undertaken in the past 3 years that is relevant to their role in our practice. † The practice manager is speci? cally mentioned in the standard, as is the term practice management training. In order to access Practice Incentive Payments, GP practices must have complied with the RACGP standards. In 2007, 80% of GP practices were accredited (AIHW, 2008). By way of context, an accredited practice with 44 R. King et al. / Management Accounting Research 21 (2010) 40–55 However, notwithstanding, for some businesses, given their lack of size and sophistication, these incentives are unlikely to outweigh the costs of budgeting which include the initial investment in software, skills, and the added labour hours. 4. Hypothesis development 4. 1. Overview This study investigates the relationship between factors identi? ed from contingency-based research, the adoption and extent of use of budgets, and business performance. The speci? contextual factors we consider are size, structure, strategy, and perceived environmental uncertainty (Chenhall, 2003). We argue, based on how each identi? ed factor is expected to impact both a business’s needs for and thereby the bene? ts it derives from budgeting, and also its ability to meet the costs of a budgeting practice, that the four contingency factors play different roles relative to the tw o stages of the budgeting decision. Speci? cally, we predict that a business’s adoption decision primarily related to its size and to a lesser extent, its structure (decentralisation). For businesses that make the threshold adoption decision, we predict that those that are more decentralised, employ a cost leadership strategy, and for which management perceives a lower level of environmental uncertainty will use budgets to a greater extent. Quite clearly, however, the roles played by the various factors ultimately remain an empirical question and as such, we give consideration to each when we empirically model the two stages of the budgeting decision. Finally, we predict that the match between the contextual factors and extent of budget use will be re? ected in business performance. These predictions are formalised below. . 2. Determinants of budgeting practice 4. 2. 1. Size The construct of size has frequently been viewed as re? ecting two dimensions, complexity and availability of resources, with both argued to be increasing with size (Fredrickson and Mitchell, 1984; Mintzberg, 1994). While small, single-business organisations can often be controlled with largely informal mechanisms such as direct supervision and oral communications, larger organisations require more formal controls as the increased complexity associated with a larger number of employees creates problems in social control, communication, and co-ordination (Lawrence and Lorsch, 1967). Here, Davila (2005) argues, following Levitt and March (1988), that to regain ef? ciency in managing the organisation, co-ordination and control mechanisms are formalised with the objective of coding and documenting organisational learning and reducing the demand that routine activities impose on the management team’s time. Further, in terms of a business’s ability to invest in a formal budgeting practice, it is widely accepted that larger businesses are better positioned given their greater resources, ? nancial and otherwise. Larger businesses not only have the resources required to acquire software and skills but they can also more ef? ciently achieve these administrative tasks through economies of scale and the greater technical specialisation of their employees (Merchant, 1981). Chenhall (2003) ? nds that size has been considered as a contextual variable in only a few MCS studies as most examine relatively large businesses. Such a ? nding ? ts well with Banbury and Nahapiet’s (1979) argument that there should only be a relationship between resource availability and the introduction of formal systems in organisations of relatively small size. Consistent with these types of arguments, small business studies reveal size as in? uencing the acquisition and preparation of accounting information including budgets (Holmes and Nicholls, 1989; McMahon, 2001). Further, evidence from longitudinal studies of startup businesses suggests that size in? uences the decision to adopt operating budgets, with larger ? rms adopting the budgets sooner (Davila and Foster, 2005, 2007). They ? nd that when the business is small, control and co-ordination happens through frequent informal interactions but that the ef? iency of an informal system requiring direct contact with employees rapidly decreases with increasing size, thereby making it more ef? cient to use a formal control system. In the primary healthcare setting, we view the ? xed costs associated with the adoption of a budgeting practice to be signi? cant and thus, following the arguments of Davila and Foster (2005), propose size as a determining contingency factor underlying the adoptio n decision. In this sector, businesses are required to comply with substantive â€Å"red tape† that places onerous demands on their resources (Productivity Commission, 2003). As such, it is likely that only larger businesses have both the need for and the resources to devote to budgeting. Smaller practices are unlikely to be able divert resources away from their primary revenue generating clinical activities. Thus, we predict a positive relationship between business size and use of budgets. However, we also argue consistent with Banbury and Nahapiet (1979) that once a business has reached a critical size and uses a budget, size is unlikely to play a signi? cant further role in the determination of budgeting practice. Thus, our ? st hypothesis, expressed in the alternative, is: H1 . The adoption of written budgets by primary healthcare businesses is positively associated with business size. 4. 2. 2. Structure The structure of a business relates to â€Å"the formal speci? cation of roles for organisational members or tasks for groups to ensure that the activities of the organisation are carried out† (Chenhall, 2003). While two components, differentia tion and integration, have been identi? ed in the literature, we focus only on differentiation because of the small size of our sample businesses. Differentiation is de? ed as the extent to which managers act as quasi-owners and is achieved through decentralisation of authority (Lawrence and Lorsch, 1967). A centralised busi- 4 FTE urban GPs would receive $60,000 per annum from PIP (Medicare, 2009). R. King et al. / Management Accounting Research 21 (2010) 40–55 45 ness structure is characterised by decision-making that is restricted to owners and upper management whereas a decentralised business delegates decision-making to lower levels of management and operational staff. Given the closer links between the ownership and control of the business, ecision-making in centralised businesses should require relatively fewer MCS. Herein, existing evidence reveals centralised businesses as having relatively few administrative controls and less sophisticated budgets while decentralise d businesses have more formal controls (Bruns and Waterhouse, 1975; Merchant, 1981). We thus argue that structure has the potential to play a role in a business’s initial decision to adopt a budgeting practice, although we view its role as secondary to size since it is unlikely that the business’s ability to meet the ? ed costs associated with a budget practice will be directly related to its structure. Further, we argue that for small healthcare businesses that have reached the threshold size and use budgets, structure also has the potential to play a role in its subsequent decision as to the extent of use. As the business becomes more differentiated, decentralisation increases and thereby so does the need for formal MCS (Lawrence and Lorsch, 1967; Merchant, 1981). Our second hypothesis, expressed in two parts and in the alternative, is then:13 H2a . The adoption of written budget by primary healthcare businesses is positively associated with business structure (decentralisation). H2b . The extent of written budget use by primary healthcare businesses which opt to use written budgets is positively associated with business structure (decentralisation). 4. 2. 3. Strategy Business strategy, de? ned as how a business chooses to compete within its particular industry (Lang? eld-Smith, 1997), has been the focus of much of the research on MCS as opposed to corporate or operational strategy (Chenhall, 2003). While there are a number of different typologies of business strategy, we use Porter’s typology which focuses on cost leadership and product differentiation strategies. Porter’s cost leaders are characterised by competitive prices, consistent quality, ease of purchase, and a relatively restricted product selection. In contrast, differentiators offer the market something perceived as unique. Different types of MCS will be suited to different strategies due to their differing information and feedback requirements. Cost leadership strategies are argued to require speci? operating goals and budgets to facilitate cost containment at an operational level (Chenhall and Morris, 1995). Alternatively, product differentiator strategies would require more outward focussed, broadscope, MCS to collect infor- mation on competitors for planning purposes (Simons, 1987). Since primary healthcare businesses have constraints on the total number of services they can provide such as opening hours and the number of medical practitioners, a cost leadership strategy should require that tighter cost controls be in place in order to maintain overall pro? ability. In contrast, a product differentiator strategy operating with higher margins under the same constraints should require fewer controls. While we do not expect strategy to be determinative of the threshold decision to use budgets as it is unlikely to either affect the business’s ability to meet the initial ? xed costs or contribute suf? ciently to the business’s primary need for a budgeting practice, based on the arguments above we do expect it to impact on the desire to invest in marginal costs associated with a greater extent of budget use. Thus, formally, our third hypothesis, expressed in the alternative, is: H3 . For small healthcare businesses, which opt to use written budgets, those following a cost leadership strategy will use budgets to a greater extent than those following a product differentiation strategy. 4. 2. 4. Perceived environmental uncertainty (PEU) PEU is de? ned as a situation where managers perceive elements of the environment to be uncertain, with uncertainty distinguished from risk â€Å"as uncertainty de? nes situations in which probabilities are not attached† (Chenhall, 2003). In a general sense, PEU is seen to be an important contextual factor in the design of MCS because increased PEU makes managerial planning and control more dif? cult (Lawrence and Lorsch, 1967). PEU is, however, a general term and a number of researchers have provided more speci? c classi? cations of the environment (Waterhouse and Tiessen, 1978; Ouchi, 1979). In this study, we focus on the two most commonly researched elements of PEU, the dynamic nature of the environment (dynamism) and the level of competition (hostility). Contingency-based research in large business has found that greater dynamism is associated with a need for more externally focussed, broad scope and timely information (Chenhall and Morris, 1995). Planning becomes more dif? cult in more dynamic conditions as probabilities cannot as easily be attached to future events and controls such as static budgets may quickly become outdated. Thus, greater informal communication is required for effective decision-making and formal controls are less bene? cial or desirable (Chapman, 1997). Alternatively, large business research focussed n hostility has found that businesses facing greater competition rely on more formal controls and emphasise budgets (Khandwalla, 1972). Thus, in addition to con? rming PEU as an important contextual factor, these ? ndings also reveal the importance of specifying the dimension of interest (Chenhall, 2003). Consistent with the research on dynamism in large business but in contrast with that on hostility, Matthews an d Scott (1995) ? nd for small businesses, the sophistication of planning decreases with both increased dynamism and increased hostility. They argue from an economic perspective that for small businesses, the more uncertain 13 While it could be argued that it would be impractical for a small business consisting of a single medical practitioner and few administrative staff to have a decentralised structure, given the heavy demands of clinical work on the medical practitioner’s time, decentralisation is possible to the extent that operational and ? nancial decision-making is delegated to employees. This was con? rmed in discussions in the pilot study. 46 R. King et al. Management Accounting Research 21 (2010) 40–55 the environment the less likely the manager is to expend scarce resources on budgets with an unproven effect on performance. The rational manager trying to meet the fundamental goal of making a pro? t will weigh up the bene? ts against the costs associated with budgeting. Based on these arguments and ? ndings, we propose that as with strategy, neither dimension of PEU is likely to impact the mana ger’s threshold decision to adopt a budget as it does not directly impact on the ability to meet the costs. However, for businesses that have already identi? ed the need and ability to budget, both dynamism and hostility will impact on the decision to incur the added marginal costs of increased budget use. Consistent with Matthews and Scott (1995) and the large organisation literature, given the relatively small nature of our sample businesses and the likely resource constraints that they face, we predict a negative association between the PEU dimension of dynamism and the extent of use. 14 However, contrary to the large rganisation literature but consistent with Matthews and Scott (1995), we also predict a negative association between the PEU dimension of hostility and the extent of use. Our fourth hypothesis, expressed in the alternative, is then: H4 . The extent of written budget use by primary healthcare businesses which opt to use written budgets is negatively associated with the PEU elements of dynamism and hostility. 4. 3. Performance and budgets Budgets have been recommended for pl anning, monitoring, and controlling business activities, with each thought to assist businesses to achieve pro? ability (Horngren et al. , 2006). However, the effect of budgets on pro? tability has not as yet been clearly demonstrated in the literature (McMahon, 2001). There is evidence of a positive association between the use of budgets and performance as proxied by growth in small and medium enterprises (Gorton, 1999). Even without extensive empirical evidence, planning and the use of appropriate budgets are promoted by academics, educators and accounting practitioners as a means of enhancing ? ancial performance (Hansen and Otley, 2003; Gorton, 1999). Thus, we might expect that primary healthcare businesses using budgets experience better performance than those that do not. More carefully, according to ‘contingency-based’ research, a state of equilibrium in the relationship between the contingency factors and the type of MCS is best described by â€Å"? t† (C ovaleski et al. , 2003). â€Å"Fit† occurs when the organisation designs its practices in such a way that it has a positive impact on performance relative to alternative practices. Thus, there will be no universally effective ‘extent of budget use’, as each combination of contingency factors will â€Å"? t† with different practices. The positive impact on performance of attaining â€Å"? t† is due to the ef? ciencies that result from using the most suitable MCS. When there is a lesser â€Å"? t† between the extent of budget use and the contingency factors, performance will be â€Å"impaired†. Further, mis? t will be associated with lower performance irrespective of whether it arises from â€Å"over-budgeting† or â€Å"under-budgeting†. Thus, our ? th hypothesis, stated in the alternate form, is: H5 . A business’s performance is positively associated with the degree of ? t between the extent of budget use and its contingency factors. The inef? ciencies arise because the need for a budgeting practice is incongruent with the adopted practice. If the business over-commits to budgeting, it is likely to ha ve expended scarce human and ? nancial resources without enjoying commensurate bene? ts. Conversely, if it under-commits, its performance will likely suffer because of control and/or co-ordination problems. To illustrate, consider the various contextual factors identi? ed above. First, regarding size, a relatively small business that uses an extensive budgeting practice will have unnecessarily expended resources implementing and operating the practice when in fact informal communication is practical and likely preferred. Conversely, a relatively large business without a formal budgeting practice will likely ? nd both communication and co-ordination problematic given the complexity associated with a larger number of employees. In a similar fashion, a relatively centralised business with an extensive budgeting practice has likely expended resources on a level of control that is greater than required to encourage employees to make decisions that are in keeping with the organisational objectives. In terms of strategy, a cost leadership strategy requires more speci? c controls than a differentiation strategy. Thus, the adopted business strategy will likely be less effective if an incompatible budgeting practice is implemented to support the strategy. Finally, high levels of PEU make it much more dif? ult to plan with certainty, thereby reducing the need for and advantages of budgeting. Finally, notwithstanding equilibrium-type arguments, we believe that there will be variation in the degree of â€Å"? t† in our setting given the dif? culties that primary healthcare businesses likely face in identifying and implementing their best budgeting practices. Given their size and medical focus, it is likely that many of our sample businesses approach budgeting from a relatively unsophisticated perspective and/or view it as a lower priority. This makes the process of identifying a practice that â€Å"? s† relatively slow and involves ‘trial and error’ type of learning. Here, Luft (1997) argues that while static equilibrium theories â€Å"can predict the techniques the ? rm should end up with† they cannot predict â€Å"how long it will take to complete the process or what the path to the solution will be. † Thus, it is likely that there will be a lag between the need for and the use of a particular budgeting practice. Milgrom and Roberts (1992) also argue that organisations are dynamically learning and moving towards an optimal level of management accounting practice. The problem of implementing a budget practice that â€Å"? s† is further complicated by the fact that implementation of new budget practices is likely to 14 The variation in PEU of manag ers from different industries has typically been the focus of previous research. In this study, industry is a constant but arguably PEU is still of interest, as it has also been found to vary among the managers of businesses within the same industry (Boyd et al. , 1993). R. King et al. / Management Accounting Research 21 (2010) 40–55 47 occur in a â€Å"lumpy† fashion because when increasing the extent to which they use budgets, businesses are forced to do so in larger rather than smaller increments. As Luft (1997) argues, â€Å"changes in information systems are often sharply discontinuous†. 5. Method 5. 1. Sample frame and description For this study, a cross-sectional research design is used and the quantitative measurement tool is a mail questionnaire. Recognised problems associated with the implementation of survey-based studies include the initial dif? culty of identifying and accessing appropriate respondents, and then of achieving acceptable response rates (Dillman, 2000). In light of this, since budgets are considered to be a traditional management tool and there is an identi? d trend towards delegating management responsibilities to practice managers, practice managers were chosen as the target subjects for the survey (Department of Health and Ageing, 2005). The further problems of contacting practice managers via a cost effective means and encouraging participation were addressed by approaching the Australian Association of Practice Managers (AAPM) for support. T he AAPM is the only recognised professional body for practice managers in Australia and consists of managers of dental, medical, and allied health businesses. Currently, there are 1200 members of the AAPM from medical practices, representing approximately 6% of the small private medical businesses operating in Australia. Membership in the AAPM is voluntary subject to an annual subscription fee. There are a number of bene? ts associated with membership including discounts for management education courses and national conferences. Thus, it is likely that members of the AAPM are interested in staying informed about current management trends, wish to become part of a professional network, and have the means to pay the membership fee. While no demographic data currently exist for practice managers who join the AAPM and those who do not, member businesses appear slightly skewed towards larger practices relative to the population of GP businesses. For 2005–2006, 83% of GP businesses had between one and ? ve GPs, with the remaining 17% having six or more (PHCRIS, 2008). In comparison, for our sample practices, 66. 4% had between one and ? ve GP’s and the remaining 33. 6%, six or more. However, notwithstanding this potential bias, the advantages of accessing the AAPM practice manager mailing list and having the AAPM recommend participation are considered to dominate. The questionnaire was initially developed from the existing literature and then pilot tested on a sample of 20 members of the AAPM and ? ve academic researchers. Based on this testing, a number of changes were made to wording and layout to enhance understandability in this setting. The ? nal questionnaire consisted of 35 questions presented in 10 sections and was estimated to require between 20 and 30 min to complete. Questions relating to each of the relevant constructs discussed in Section 4 were presented in dedicated and clearly labelled sections. The ? nal questionnaire was sent to a random sample of 1000 of the medical practice members of the AAPM. Of the 1000 surveys distributed, 12 were returned unopened. From the remaining 988 questionnaires, 144 complete and usable responses were received, representing a 14. 6% response rate which is comparable with those achieved in other studies of small businesses (Dennis, 2003). 15 Requested demographic data reveal 112 of the practices to be GP practices and 32 to be specialist practices, and that they employed between 2 and 42 full-time equivalents (FTE). Further, 98. 6% indicate that they use computers in some capacity. The average age of the practices is 23. 94 years, and for the 114 organisations that responded to the question, their average gross fees were $1,553,919, ranging from $206,816 to $11,000,000. 5. 2. Budgeting practice 5. 2. 1. Empirical model The ? rst stage of this study seeks insights both into the factors underlying a business’s decision to adopt a budgeting practice and into its subsequent decision as to the extent of budget use. To do so, it appeals to contingencybased research to identify four contextual factors (size (SIZE), structure (STRUC), strategy (STRAT), and perceived environmental uncertainty (PEU)) argued to drive the decisions, although in different combinations. Given this framework, we employ the following common empirical model to formally examine each of these two decisions: BUDGi = + 1 lnSIZEi 0 + 2 STRUCi + 3 STRATi + 4 PEUi + 5 TYPEi +? (1) where the various measures are described below. For the decision to adopt, based on H1 and H2a , 1 and 2 are predicted to be positive. For the decision as to the extent of use, based on H2b , H3 , and H4 , 2 and 3 are predicted to be positive and 4 negative. Practice type (TYPE) has been included in the model to control for potential structural differences (Hair et al. , 2006). Speci? cally, identi? ed differences in the pricing (higher) and supply (lower) of services by specialist versus general practices suggest that the market for specialist services may be relatively more heterogeneous (Department of Health and Ageing, 2005). We measure TYPE as a dichotomous variable, set equal to 1 for general practices and 0 for specialist practices. . 2. 2. Dependent variable measurement To examine the decision to adopt, we measure BUDG as a dichotomous variable set equal to 1 if the business indicates, in response to an explicit ‘yes/no’ question, that it 15 The mailing was restricted to 1000 questionnaires due to ? nancial constraints. Standard techniques to discourage non-response were employed including a per sonalised cover letter from the AAPM, promised con? dentiality, brevity of questions, the inclusion of a reply-paid envelope, a follow-up e-mail reminder, and a promise to make results available to participants (Dillman, 2000). Testing for non-response bias, undertaken by comparing 15 responses received in the ? rst month to the ? nal 15 responses received, revealed no statistically signi? cant differences. 48 R. King et al. / Management Accounting Research 21 (2010) 40–55 uses a written budget and 0 otherwise. We base this analysis on all 144 respondents and run Eq. (1) as a logistic regression. For this and all subsequent analysis, reported p-values are one-tailed since we have predictions relating to each of the contingency factors. To examine the extent of budget use, we restrict our tests to the 65 respondents using written budgets. Here, the survey questionnaire asked respondents to indicate on a 5-point Likert scale how systematically their business used operating budgets of various durations (annual, halfyearly, quarterly, monthly, and/or weekly), as well as cash ? ow, ? exible, rolling, long-term, or other budgets. These questions capture both the types of budgets used and the extent of their use, and are an adaptation of the alternative measurement approaches used in Chenhall and Lang? eldSmith (1998) and Jankala (2005). 16 The Cronbach’s alpha is 93. 8%. Panel A of Table 1 presents descriptive statistics for the responses relating to the usage of each type f budget. To construct the ‘extent of budget use’ measure, we apply exploratory common factor analysis with orthogonal rotation to the responses. Two uncorrelated factors with eigenvalues of 3. 845 and 1. 234 are extracted, explaining 64. 14% of the total variance. The factor loadings are presented in the ? nal two columns of Panel A of Table 1. The ? rst factor aligns with operating budgets and the second with other types of budgets. As such, we consider two sub-categories (‘operating budgets’ and ‘other budgets’) and measure BUDG for each as the average summated budget usage score across the relevant budgets in the subcategory. 7 Here, Eq. (1) is run using OLS. Given a consistent lack of signi? cance, we do not report or discuss results based on our analyses of the ‘other budgets’ measure. 5. 2. 3. Contingency factor measurement Following the majority of contingency-based MCS studies, we measure size (SIZE) as the number of full-time equivalent (FTE) employees (Chenhall, 2003). Respondents were asked to identify the number of FTE employees as administrative/reception staff, practice manager, nursing/allied health, medical, and other. Table 2 reveals that the mean (median) number of FTE employees for our sample businesses is 11. 31 (10. 500). For sensitivity purposes, we a lternatively consider gross fees as a measure of size. Data on gross fees were provided by 114 of the businesses, with a mean (median) value of $1,553,919 ($1,322,359). For the remaining three contingency factors, the measures are based on responses across 7-point Likert scales to dedicated questions in the questionnaire survey. Panel B of Table 1 presents the questions and descriptive statistics for the responses. For STRUC and PEU which involve multiple questions, exploratory common factor analysis is then applied o develop the empirical measures. The factor loadings are presented in the ? nal two columns of Panel B. 18 In detail, the measure of structure (STRUC) is based on responses to six questionnaire items asking the extent to which decision-making authority has been delegated within the business and at which level operating decisions are made. The six items, originally developed by Gordon and Narayanan (1984), have been subjected to considerable scrutiny and empirical testin g for reliability and validity in previous research (Chenhall, 2003). The Cronbach alpha is 82. 7%. Application of exploratory common factor analysis to the response scores leads to the extraction of only one factor with an eigenvalue of 3. 261, explaining 53. 81% of the variance. Thus, STRUC is measured as the average summated scores across the six items. Organisational strategy (STRAT) is based on Porter’s classi? cation scheme (Porter, 1980) and measured by the response to a single question drawn from Govindarajan (1988). This question asks the respondents to indicate their belief as to the best description of the business’s strategic emphasis, ranging from product differentiation to cost leadership. This was found in the pilot testing to be the only question from previous research applicable to our setting, Finally, we initially measure perceived environmental uncertainty (PEU) based on the responses to nine questions developed by Gordon and Narayanan (1984) to capture the intensity of competition, the dynamic and unpredictable nature of the external environment, and the potential elements of change in the environment. Based on the correlations among the responses, only ? ve items were eventually used with a Cronbach alpha of 64. %, as the responses to four items had correlations of less than the 30% level recommended for inclusion in factor analysis (Hair et al. , 2006). 19 Consistent with previous research (Gordon and Narayanan, 1984), application of exploratory common factor analysis with orthogonal rotation led to the extraction of two factors with eigenvalues of 2. 327 and 1. 122 explaining 67. 70% of the total variance. Following the literature, we label these factors as à ¢â‚¬ËœPEU hostility’ (PEUhost ) and ‘PEU dynamism’ (PEUdyn ). PEUhost loads on the two questions relating to the competitiveness of the business environment whereas PEUdyn loads on the three questions relating to the predictability of the external environment. We include both in our empirical model, measuring each as the average summated response scores across the relevant questions. 16 Jankala (2005) prefers this measure of systematic use as a more reliable and precise measure of a business’s commitment to the use of budgets, rather than the more subjective scales used by, for example, Chenhall and Lang? eld-Smith (1998) that measure bene? t derived. 7 The yearly operating budgets did not load on either factor as a large majority of the businesses indicated that they used yearly operating budgets on a systematic basis. 18 The reported factor loadings, eigenvalues, and percentage variation explained are based on the full sample of 144 respondents. When the exploratory common factor analysis is repeated based only on the 65 respondent bus inesses using budgets, all measures are qualitatively identical. 19 The four items removed were competition for manpower, new services marketed, ability to predict preferences for customers, and change in legal, political, and economic environment. Their removal is perhaps not surprising that as there was little variation in the responses received with the sample small businesses drawn from the same industry. R. King et al. / Management Accounting Research 21 (2010) 40–55 Table 1 Descriptive statistics and factor loadings for survey questionnaire responses. Question Descriptive statistics Mean Panel A: Budgeting BUDG 1 Which of the following budgets are prepared and how consistently? (5-point scale: 1 = not used, 2 = seldom, 3 = at times, 4 = often, 5 = systematically) a. Operating budget, yearly b. Operating budget, half-yearly c. Operating budget, quarterly d. Operating budget, monthly e. Operating budget, weekly f. Cash ? ow budget g. Flexible budget h. Rolling budget i. Long-term budget Med SD Factor loadings #1 #2 49 2. 690 2. 064 2. 064 2. 092 1. 578 2. 079 1. 701 1. 704 1. 795 1 1 1 1 1 1 1 1 1 1. 899 1. 663 1. 659 1. 662 1. 315 1. 626 1. 317 1. 400 1. 473 0. 746 0. 614 0. 533 0. 668 0. 472 0. 149 0. 317 0. 168 0. 255 0. 322 0. 034 0. 346 0. 508 0. 823 0. 606 0. 715 Panel B: Contingency factors Structure (STRUC) STRUC 1 To what extent has authority been delegated to the manager or employee for each of the following decisions? Please indicate actual rather than stated authority) (7-point scale: 1 = no delegation, 7 = total delegation) a. Initiate ideas for new services b. Hiring and ? ring of personnel c. Selection of large investments d. Budget allocations e. Pricing decisions STRUC 2 Most operation decisions are made at what level? (7-point scale: 1 = owner level, 7 = manager level) 4. 999 5. 250 3. 173 3. 980 4. 311 4. 349 5 6 3 5 5 4 1. 517 1. 923 1. 963 2. 123 1. 900 1. 870 0. 531 0. 610 0. 732 0. 803 0. 761 0. 581 – – – – – – How would you best describe your practice’s strategic emphasis? 7-point scale: 1 = product differentiation; 7 = cost leadership) Perceived environmental uncertainty (PEU) PEU 1 How stable/dynamic is the external environment (economic and technological) facing your practice? (7-point scale: 1 = very stable, 7 = very dynamic) a. Economic environment b. Technological environment PEU 2 How would you classify the market activities of your competitors (i. e. , other healthcare practices) in the past 3 years? (7-point scale: 1 = becoming more predictable, 7 = becoming less predictable) How intense is each of the following in your industry, the healthcare profession? 7-point scale: 1 = negligible, 7 = intense) a. Bidding for purchases b. Price competition Strategy (STRAT) STRAT 1 2. 983 3 1. 127 n/a n/a 4. 134 4. 7 61 3. 691 4 5 4 1. 603 1. 596 1. 122 0. 968 0. 755 0. 369 0. 176 0. 185 0. 118 PEU 3 2. 446 3. 553 2 4 1. 352 1. 502 0. 147 0. 168 0. 676 0. 625 Panel C: Performance (PERF) PERF 1 Which best describes your response to the following statements over the past 3-year period? Compared to key competitors, my practice: (7-point scale: 1 = strongly disagree, 7 = strongly agree) a. Is more competitive b. Has more patients c. Is growing faster d. Is more pro? table e. Is more innovative f. Has more doctors 5. 082 5. 353 5. 105 5. 210 5. 320 4. 094 5 6 5 5 6 4 1. 607 1. 619 1. 644 1. 593 1. 643 2. 204 0. 660 0. 711 0. 849 0. 667 0. 592 0. 502 – – – – – For Panel A, the exploratory factor analysis was conducted based on the 65 businesses that produce written budgets. For Panels B and C, the exploratory common factor analysis was based on the full sample of 144 respondents. Items deemed to load on the identi? ed factor appear in bold. 50 R. King et al. / Management Accounting Research 21 (2010) 40–55 Table 2 Descriptive statistics for ‘contingency-based’ model variables. Measure ‘Operating budgets’ Mean Median Standard deviation Min max Size (SIZE) Mean Median Standard deviation Min max Structure (STRUCT) Mean Median Standard deviation Min max Strategy (STRAT) Mean Median Standard deviation Min max PEUhost Mean Median Standard deviation Min max PEUdyn Mean Median Standard deviation Min max Performance (PERF) Mean Median Standard deviation Min max Full sample (n = 144) 1. 948 1. 000 1. 376 15 11. 531 10. 500 6. 583 2 42 4. 344 4. 333 1. 381 17 1. 990 2. 000 1. 122 17 2. 987 3. 000 1. 199 16 4. 201 4. 333 1. 179 1 6. 6 4. 027 4. 083 1. 248 17 Written budget (n = 65) 3. 085 3. 000 1. 50 15 12. 893 12. 000 6. 367 3. 5 31 4. 862 5. 000 1. 212 1. 67 6. 83 1. 860 2. 000 1. 014 16 3. 231 3. 000 1. 183 16 4. 241 4. 333 1. 129 1 6. 67 4. 228 4. 333 1. 302 17 No written budget (n = 79) n/a p-Value – 10. 410 9. 250 6. 586 2 42 3. 918 3. 833 1. 372 17 2. 090 2. 000 1. 200 17 2. 785 2. 500 1. 181 1 5. 5 4. 169 4. 333 1. 224 1 6. 67 3. 861 3. 833 1. 184 1 6. 5 0. 024 0) or â€Å"under-budgets† (? 0), the impact of ‘lack of ? t’ on ? nancial performance should be the same. Formally, the model we employ, illustrated using |? |, has the following form: PERFi = 0 we also requested objective measures of pro? ability from our sample businesses (Govindarajan and Gupta, 1985). Unfortunately, less than one-third of our sample provided the data. Thus, the use of objective measures for robustness purposes is also impractical. 6. Results and analysis 6. 1. Preliminaries Descriptive statistics for measures used in tests of our hypotheses are presented in Table 2, both for the overall sample of 144 respondents and for the sample partitioned on the basis of whether a written budget is adopted, along with tests for differences in mean values between partitions. As revealed, there is considerable cross-sectional variation in each measure. Further, there appear to be several signi? cant differences between respondents adopting written budgets and those not. Speci? cally, businesses using budgets have more FTE employees (SIZE, p = 0. 024), are more decentralised (STRUC, p 0. 001), face a more hostile enviro How to cite Budgeting Practices and Performance in Small Healthcare Businesses, Papers

Budgeting Practices and Performance in Small Healthcare Businesses Free Essays

string(115) " adoption of budgets and the extent of their use for our sample of small Australian primary healthcare businesses\." Management Accounting Research 21 (2010) 40–55 Contents lists available at ScienceDirect Management Accounting Research journal homepage: www. elsevier. com/locate/mar Budgeting practices and performance in small healthcare businesses Robyn King a , Peter M. We will write a custom essay sample on Budgeting Practices and Performance in Small Healthcare Businesses or any similar topic only for you Order Now Clarkson a,b,? , Sandra Wallace c a b c UQ Business School, The University of Queensland, Brisbane 4072, Australia Faculty of Business Administration, Simon Fraser University, Burnaby, Canada V5A 1S6 Department of Accounting and BIS, The University of Melbourne, Victoria 3010, Australia a r t i c l e i n f o a b s t r a c t We present evidence linking primary healthcare business characteristics, budgeting practices, and business performance. Based on a sample of 144 responses from a survey of members of the Australian Association of Practice Managers (AAPM), we ? nd that factors identi? ed by contingency-based research are useful for predicting a business’s budgeting practices. Speci? cally, we ? nd the adoption of written budgets to be related to size and structure, and for businesses using written budgets, the extent of use is related to business structure, strategy and perceived environmental uncertainty. Finally, we ? nd evidence of a relationship between budgeting practice and performance. Here, we initially ? nd a business’s performance to be positively associated with the use of written budgets. More re? ned tests of the â€Å"? t† between business contingency factors and extent of operating budget use then provide evidence of a positive association between the extent of â€Å"? t† and performance. Crown Copyright  © 2009 Published by Elsevier Ltd. All rights reserved. Keywords: Budgeting SME Healthcare businesses . Introduction This study investigates the relationship between contextual factors identi? ed from contingency-based research, the adoption and extent of use of budgets, and business performance within the Australian primary healthcare setting. 1 We focus on budgets because they are considered to be one of the main management control systems This study is based largely on Robyn King’s Honours thesis completed in the UQ Business School at the University of Queensland. The authors would like to thank the editor and the two anonymous referees, as well as workshop participants at Monash and Swinburne Universities, the 2007 AFAANZ Annual Conference, and especially Aldonio Ferreira, Axel Schultz, Shannon Anderson and Julie Walker for comments on an earlier version of the manuscript. ? Corresponding author at: UQ Business School, The University of Queensland, Brisbane 4072, Australia. Tel. : +61 7 3346 8015; fax: +61 7 3365 6788. E-mail address: P. Clarkson@business. uq. edu. au (P. M. Clarkson). Primary healthcare is the initial care of a patient as an outpatient excluding diagnostic testing; tertiary healthcare is that provided in a hospital setting. (MCS) in organisations, have been found to be the earliest MCS that a business adopts, and continue to receive signi? cant attention in the research literature and in teaching material (e. g. , Davila and Foster, 2005, 2007; Sandino, 2007). We select the Australian primary healthcare sector as our experim ental setting both because of its importance socially and economically, and because it is likely to be comprised of businesses that vary broadly in their budgeting practices. Contingency-based research proposes that there is no single MCS suitable for all businesses. Instead, the suitability of a particular MCS is argued to be contingent upon characteristics of a business including its size, strategy, structure, and also management’s perceptions of the uncertainty of the environment within which the business operates. We begin by examining the relationship between a business’s budgeting practices and these four contextual factors. In so doing, we view the development of a budgeting practice as consisting of two stages, the initial decision regarding adoption and the subsequent decision regarding extent of use. Here, the term ‘adoption’ re? ects the decision by a business to use a formal process to project its future 1044-5005/$ – see front matter. Crown Copyright  © 2009 Published by Elsevier Ltd. All rights reserved. doi:10. 1016/j. mar. 2009. 11. 002 R. King et al. / Management Accounting Research 21 (2010) 40–55 41 ?nancial performance (Davila and Foster, 2005). Alternatively, the term ‘extent of use’ refers to both the number of different types of budgets the business uses and the frequency of their use. In our analysis, we develop arguments for, and investigate, these two stages separately. We then turn to consider the relationship between a business’s budgeting practice and its performance. The relative â€Å"? t† of the business’s MCS with its contingency factors is argued to impact on performance, with performance increasing with the degree of â€Å"? t† (Chenhall, 2003). Thus, ceterus paribus, businesses using a practice which does not â€Å"? t†, whether by â€Å"over-budgeting† or â€Å"under-budgeting†, are expected to experience weaker performance. We argue that not all of our sample businesses are likely to exhibit â€Å"best budgeting practice† because of the dif? ulties associated with identifying and implementing best practice, and the discontinuous nature of upgrades (Luft, 1997). We examine the relation between â€Å"? t† and performance using the method proposed by Ittner and Larcker (2001) and classi? ed as a Cartesian/Contingency approach (Gerdin and Greve, 2004). Degree of â€Å"? t† is measured as the difference between the extent of budget use and that predicted by the business’s contingency factors. This approach assumes that at any point, not all businesses will in fact have implemented their optimal practice. To conduct our investigation, a written survey of 988 members of the Australian Association of Practice Managers (AAPM) was undertaken. In brief, we ? nd that larger, more decentralised healthcare businesses are more likely to adopt written budgets. Further, for the subset of businesses that use written budgets, we ? nd that the extent of budget use is positively associated with structure (decentralisation) and strategy (cost leadership), and negatively associated with perceived environmental uncertainty (dynamism). Finally, we document a relationship between choice of budgeting practice and performance. Here, we initially ? nd performance to be positively associated with the use of written budgets. More re? ned tests then provide evidence of a positive association between the degree of â€Å"? t† and performance. Our study makes several contributions. First, we present evidence that contingency factors do indeed provide insights into both the adoption of budgets and the extent of their use for our sample of small Australian primary healthcare businesses. You read "Budgeting Practices and Performance in Small Healthcare Businesses" in category "Papers" Interestingly, the results suggest that size and structure capture the business’s initial decision to adopt a formal budgeting practice. However, once a business has adopted a formal practice, strategy, structure, and perceived environmental uncertainty appear to be the primary determinants underlying the subsequent decision regarding the extent of budget use. We also present evidence that the â€Å"? t† of our sample business’s budgeting practices is associated with performance. To our knowledge, there has been relatively little empirical evidence on this relationship documented in the literature to date. Second, contingency-based research has predominantly been conducted in the large business sector. We extend this work by examining a small business setting. We argue that our setting has the advantage of allowing for an examination not only of the extent of budget use but also of the initial decision to adopt a budgeting practice. In con- junction, it also provides an opportunity to examine more closely the different underlying theoretical constructs of size that the two most commonly used proxies, gross fees and full-time equivalent employees, may be capturing. Finally, from a practical perspective the healthcare sector is under continuing pressure to increase its ef? iency. This study contributes by examining the contexts in which the use of budgets is associated with enhanced performance in primary healthcare. The results should be of bene? t to both practitioners and those who advise practitioners on MCS design. The remainder of this paper is structured as follows: Section 2 presents background material; Section 3 describes our experimental setting; Section 4 presents the hyp otheses, Section 5 the method and Section 6 the results; and Section 7 provides a summary and conclusions. 2. Background MCS have been de? ed as all devices and systems that businesses use â€Å"to ensure that the behaviours and decisions of their employees are consistent with the organisation’s objectives and strategies† (Malmi and Brown, 2008). We focus on a business’s decision regarding its budgeting practices. Budgets are considered an MCS because they can in? uence the behaviours and decisions of employees by translating a business’s objectives into plans for action, communicating the objectives, and providing a benchmark against which to assess performance. We view budgets as both an important and appropriate focus given that they are considered to be one of the main MCS in organisations, have been found to be the earliest system adopted in startup businesses, and continue to receive signi? cant attention in the research literature and in teaching material (Davila and Foster, 2005, 2007; Sandino, 2007). Within the MCS literature, the term ‘budgeting’ is used to refer to a broad range of topics (see Chapman et al. (2007) for a review). In this study, we de? e a budget as a forward looking set of numbers which projects the future ? nancial performance of a business, and which is useful for evaluating the ? nancial viability of the business’s chosen strategy or deciding whether changes to the overall plan are required (Davila and Foster, 2005). Budgets have been identi? ed as playing a number of roles which include making goals explicit, coding learning, facilitating co-ordination, promoting accountability, facilitating control, and contracting with external parties (Davila et al. 2009). Bene? ts of budgeting include increasing ef? ciency through planning and co-ordination, supporting both control and learning through the comparison of actual results with plans, and more globally â€Å"the ability to weave together all the disparate threads of an organisation into a comprehensive plan that serves many purposes† (Hansen and Otley, 2003). Given these various roles and potential bene? ts, one might expect all businesses to adopt a formal budgeting practice. In fact, this view appears to underlie much of the empirical MCS research predominantly conducted in a large business setting, as it is often assumed that large businesses will already have formal MCS that can be readily examined (Chenhall, 2003). Here, the focus has typically 42 R. King et al. / Management Accounting Research 21 (2010) 40–55 been on the adoption and performance implications of speci? c MCS â€Å"innovations† like activity based costing (ABC) (Ittner et al. , 2002). However, it is argued in the MCS literature that a rational adoption decision should require an evaluation of the associated costs as well as the bene? s (Davila and Foster, 2005). Costs of a formal MCS include the easily measured out of pocket costs associated with implementing and operating the system (Hansen and Otley, 2003; Hansen and Van der Stede, 2004). Other costs that are not so easily measured are the possibility that budgets create rigidity thereby limiting co-operation and creati ve response, over-emphasise short-term cost control and top down authority, encourage gaming, and de-motivate employees (Hansen and Otley, 2003; Hansen and Van der Stede, 2004). Further, arguably the bene? s and costs associated with adopting a formal budgeting practice will not be the same for every business but will depend on business-speci? c contextual factors. Thus, ex ante, it is not clear that adoption of a formal budgeting practice is necessarily a rational outcome for all businesses. Our study distinguishes itself from the majority of the MCS literature by focusing on the small business setting, speci? cally the primary healthcare business sector. Within this sector, we argue that it is likely that for some businesses, the costs of budgeting will outweigh the perceived bene? s whereas the converse will likely be true for others. Thus, we argue that this setting provides the opportunity to gain insights into both the decision regarding the adoption of budgets as well as the subsequent decision regarding the extent of their use. We investigate the contextual factors that delineate the costs and bene? ts associated with budgeting from a contingency framework perspective. Our initial focus is on the contextual factors that differentiate adopters from non-adopters. We then consider those factors that drive the decision regarding the extent of budget use and conclude with an investigation into the relationship between the ? t of a business’s budgeting practice with its contextual factors and its performance. In adopting a contingency framework perspective, we acknowledge that research referring to contingency theory has been subject to the criticism that contingency is a general idea rather than a theory as â€Å"there is no a priori intuition of its own as to what the pertinent factors are and as to their likely consequences† (Spekle, 2001). In this study, we do not consider contingency as a theory but rather as a framework for investigating identi? ed factors for which we have a priori intuition based on other organisational, economic and sociological theories. A further criticism of the contingency-based literature is its simplistic nature of investigating one contextual factor or MCS at a time (Fisher, 1995). In the face of this criticism, some studies have begun investigating multiple contextual variables simultaneously (Hansen and Van der Stede, 2004; Cadez and Guilding, 2008). We also consider multiple contextual factors, speci? cally those identi? ed in Chenhall’s (2003) review of the MCS literature since 1980. This review con? rms environment, technology,3 structure and size as â€Å"the descriptors of the fundamental generic elements of context†. Strategy is also included as it emerged in the 1980s as an important factor that in? uences the design of MCS (Lang? eld-Smith, 1997). Finally, contingenc y-based research has its roots in sociology. The underlying premise of sociology is that humans are boundedly rational and satis? cing (March and Simon, 1958). Bounded rationality can impede decision-making as not all possible alternatives are known with certainty at a given point in time. One identi? ed role of MCS is to assist managers in decision-making (Lawrence and Lorsch, 1967). However, the decision on the optimal MCS is itself restricted by bounded rationality, as well as the personal incentives of the manager. Thus, while conceptually organisations may be expected to use the optimal MCS, this is not always possible. Businesses facing the same contextual factors may therefore choose different MCS, with the differences re? cted in their performance. In our study, we investigate the effect of a mismatch between the contextual variables and the extent of use of budgets on performance. 3. Experimental setting We adopt the Australian primary healthcare sector as our experimental setting for two reasons. First, we view it as an inherently interesting research setting in its own right, given its importance both socially and economically. S econd, we believe it to be an ideal setting within which to conduct an investigation into budgeting because as argued below, it is a sector within which there are likely both signi? ant incentives and disincentives to budget. Thus, this setting provides the advantages of the controls that arise from working within a single industry while at the same time, one within which variation in budget use can reasonably be expected. 4 In detail, the Australian primary healthcare sector plays a uniquely important role in terms of both the services it provides and its place in the economy. In terms of services, it represents the gateway through which patients most typically enter the health system. Initial contact with For a sample of 57 organisational units, all with budgeting practices in place, Hansen and Van der Stede (2004) undertook an exploratory study focusing on four contextual factors (strategy, structure, environment, and size) as possible antecedents to identi? ed reasons to budget. Alternatively, for a sample of large businesses, mostly manufacturing from Slovenia, Cadez and Guilding (2008) ? nd that superior performance results from an appropriate match between the contingent factors strategy, size, and market orientation, and strategic management accounting applications. We initially considered technology as an additional contextual variable but decided against its inclusion given our choice of experimental setting. Recent advances in medical technology have impacted on diagnostic specialties such as pathology and radiology (specialties not included in our study) to a much greater degree than primary healthcare. With the exception of three opthalmologists, the only specialists included in the survey were those that provide outpatient services from private rooms and like GP’s, still largely rely on their skill and basic instruments such as the stethoscope. From an administrative and medical records perspective, the use of technology is widespread, with computers being used in 89. 8% of all GP practices and 94. 5% of all specialist practices in 2002 (ABS, 2002). 4 In this regard, Merchant (1981) suggested that a desirable extension of budgeting studies guided by contingency frameworks would be to collect data from samples chosen to magnify the variation on the dimensions of interest while controlling for the many possible interacting factors which obscure or distort the ? ndings. R. King et al. Management Accounting Research 21 (2010) 40–55 43 the health system is through a general medical practitioner (GP). For specialised care, patients are then referred to specialist medical practitioners. GPs and specialists provide this primary care from private consulting rooms and refer on to other providers for diagnostic tests. 5 Economically, the sector contributed 1. 71% of GDP in 2007 (AIHW, 2008). 6 Faced with rising costs, doctor sh ortages and increasing waiting times, primary healthcare businesses are increasingly under pressure to become more ef? ient (Department of Health and Ageing, 2005). Here, budgeting has been identi? ed as a management accounting tool that enhances ? nancial performance and improves ef? ciency (Davila and Foster, 2007). Further, the majority of the existing management accounting research has been focussed on in-hospital care so little is known about MCS in the outpatient setting (Abernethy et al. , 2007), with the exception of a recent U. S. -based study of the relation between performance-based compensation and ownership of primary healthcare businesses (Ittner et al. 2007). Taken together, these facts reinforce our view that the primary healthcare sector within Australia is an important and potentially fruitful setting for the conduct of MCS research generally, and research into budgeting practices more narrowly. More directly to the current investigation, we seek an experimental se tting with variation in budget use, including the presence of both adopters and non-adopters. We believe that a number of factors conspire to make the primary healthcare sector a reasonable choice, ex ante. First, the small business sector has been argued to have lower levels of formal planning and control (Chenhall and Lang? eld-Smith, 1998). As such, it might also be expected to include non-adopters. 7 In Australia, primary healthcare is largely provided by private businesses owned by the doctors working in the business as sole traders, in partnership, or through a company. Management of these businesses has traditionally been by the owner, although there now appears to be a trend towards the delegation of management to practice managers. 8 These primary healthcare businesses typically have fewer than 50 employees and would thereby most often be classi? ed as small businesses according to the OECD de? nition (Holmes and Kelly, 1989). 9 Second, prior research also ? nds that rapid growth small-to-medium enterprises (SME) provide more extensive future-oriented ? nancial reporting than matched non-growth concerns (McMahon, 2001). Arguably, small primary healthcare businesses are less likely to be rapidly growing as there is currently an undersupply of primary healthcare workers due to an ageing workforce and restrictions on training places. 0 These limited organic growth prospects further our expectations of ? nding non-adopters. Third, ? rms within the service sector typically do not need to account for stock, thereby eliminating one driving force behind the use of sophisticated MCS. Finally, research on small and family business supports the view that necessary management skills are required before planning can be initia ted (Gibb and Scott, 1985). Since there is a lower likelihood that primary healthcare owners, the majority of whom are doctors, have formal training in MCS, non-adoption is even more likely relative to other service sectors. Conversely, there are also economic incentives to adopt budgets. As noted, primary healthcare businesses are under increasing pressure to become more ef? cient. The National Health Performance Committee has adopted a framework speci? cally designed for measuring healthcare system performance, with one of the identi? ed components being ef? ciency. In response, a number of institutions and private management consultants now offer education on managing primary healthcare practices that includes training on budgeting. 1 In conjunction, there is the added incentive to undertake these education programs in that continuing education is a requirement of the accreditation process for GP practices. Further, only accredited practices can access Practice Incentive Payments (PIP) from the Federal Government which can represent signi? cant additional revenue. 12 5 There is currently no Medicare funding for diagnostic services provided within the primary healthcare setting and so, these businesses do not invest in the associated technology. The specialist practices included in the study were the private rooms of orthopaedic surgeons, opthalmologists, ermatologists, gynaecologists, and gastroenterologists. These specialists conduct initial consultation and post operative follow up from their private rooms but perform procedures in hospitals or day surgeries for which they have visitation rights, using equipment supplied by the hospital/day surgery where a fee is charged directly to the patient for its use. 6 Overall, the healthcare industry contributed 8. 98% of GDP in 2006–2007, with 19% of recurrent health expenditure on medical services provided by GP’s and specialists. In 2006–2007, Medicare paid $4029. million for GP services, representing an average 4. 93 items per capita (AIHW, 2008). 7 In contrast, international studies of formal budget use have focused on large businesses, ? nding the vast majority use annual ? xed budgets (Horngren et al. , 2006 ). Australian evidence is consistent, with 97% of large businesses found to use budgets (Chenhall and Lang? eld-Smith, 1998). 8 The exact extent to which management is being delegated to practice managers is uncertain given a lack of studies into the prevalence or role of practice managers (Department of Health and Ageing, 2005). There were 9600 private GP practices operating in Australia at the end of June 2002. Of these, 68. 5% were single practitioner practices employing 2. 9 persons on average, and only 100 employed more than 10 practitioners. At the same time, there were 9864 private specialist practices, 89. 7% of which were solo specialist practices employing an average 3. 2 persons and only 19. 2% had greater than 10 practitioners (ABS, 2002). 10 There has been a recognised unfavourable long-term trend since 1999 towards an increasing percentage of primary care practitioners aged 55 years or over. In conjunction, the World Health Organisation (WHO) predicts a global workforce shortage of 4. 25 million health workers over the next decade (Cresswell, 2007). 11 The 2008–2009 Federal Government Budget proposal includes administered Program 5. 3—‘Primary Care Policy, Innovation and Research’ which among other things, â€Å"funds initiatives to improve service delivery and help GPs access current best business practice. † As a part of their response, the Australian Medical Association (AMA) and the AAPM have made available speci? cally tailored business education programs for healthcare managers. 2 The Royal Australian College of General Practitioners (RACGP) standards for general practice include: â€Å"Our administrative staff can describe (and there is evidence of) training undertaken in the past 3 years that is relevant to their role in our practice. † The practice manager is speci? cally mentioned in the standard, as is the term practice management training. In order to access Practice Incentive Payments, GP practices must have complied with the RACGP standards. In 2007, 80% of GP practices were accredited (AIHW, 2008). By way of context, an accredited practice with 44 R. King et al. / Management Accounting Research 21 (2010) 40–55 However, notwithstanding, for some businesses, given their lack of size and sophistication, these incentives are unlikely to outweigh the costs of budgeting which include the initial investment in software, skills, and the added labour hours. 4. Hypothesis development 4. 1. Overview This study investigates the relationship between factors identi? ed from contingency-based research, the adoption and extent of use of budgets, and business performance. The speci? contextual factors we consider are size, structure, strategy, and perceived environmental uncertainty (Chenhall, 2003). We argue, based on how each identi? ed factor is expected to impact both a business’s needs for and thereby the bene? ts it derives from budgeting, and also its ability to meet the costs of a budgeting practice, that the four contingency factors play different roles relative to the tw o stages of the budgeting decision. Speci? cally, we predict that a business’s adoption decision primarily related to its size and to a lesser extent, its structure (decentralisation). For businesses that make the threshold adoption decision, we predict that those that are more decentralised, employ a cost leadership strategy, and for which management perceives a lower level of environmental uncertainty will use budgets to a greater extent. Quite clearly, however, the roles played by the various factors ultimately remain an empirical question and as such, we give consideration to each when we empirically model the two stages of the budgeting decision. Finally, we predict that the match between the contextual factors and extent of budget use will be re? ected in business performance. These predictions are formalised below. . 2. Determinants of budgeting practice 4. 2. 1. Size The construct of size has frequently been viewed as re? ecting two dimensions, complexity and availability of resources, with both argued to be increasing with size (Fredrickson and Mitchell, 1984; Mintzberg, 1994). While small, single-business organisations can often be controlled with largely informal mechanisms such as direct supervision and oral communications, larger organisations require more formal controls as the increased complexity associated with a larger number of employees creates problems in social control, communication, and co-ordination (Lawrence and Lorsch, 1967). Here, Davila (2005) argues, following Levitt and March (1988), that to regain ef? ciency in managing the organisation, co-ordination and control mechanisms are formalised with the objective of coding and documenting organisational learning and reducing the demand that routine activities impose on the management team’s time. Further, in terms of a business’s ability to invest in a formal budgeting practice, it is widely accepted that larger businesses are better positioned given their greater resources, ? nancial and otherwise. Larger businesses not only have the resources required to acquire software and skills but they can also more ef? ciently achieve these administrative tasks through economies of scale and the greater technical specialisation of their employees (Merchant, 1981). Chenhall (2003) ? nds that size has been considered as a contextual variable in only a few MCS studies as most examine relatively large businesses. Such a ? nding ? ts well with Banbury and Nahapiet’s (1979) argument that there should only be a relationship between resource availability and the introduction of formal systems in organisations of relatively small size. Consistent with these types of arguments, small business studies reveal size as in? uencing the acquisition and preparation of accounting information including budgets (Holmes and Nicholls, 1989; McMahon, 2001). Further, evidence from longitudinal studies of startup businesses suggests that size in? uences the decision to adopt operating budgets, with larger ? rms adopting the budgets sooner (Davila and Foster, 2005, 2007). They ? nd that when the business is small, control and co-ordination happens through frequent informal interactions but that the ef? iency of an informal system requiring direct contact with employees rapidly decreases with increasing size, thereby making it more ef? cient to use a formal control system. In the primary healthcare setting, we view the ? xed costs associated with the adoption of a budgeting practice to be signi? cant and thus, following the arguments of Davila and Foster (2005), propose size as a determining contingency factor underlying the adoptio n decision. In this sector, businesses are required to comply with substantive â€Å"red tape† that places onerous demands on their resources (Productivity Commission, 2003). As such, it is likely that only larger businesses have both the need for and the resources to devote to budgeting. Smaller practices are unlikely to be able divert resources away from their primary revenue generating clinical activities. Thus, we predict a positive relationship between business size and use of budgets. However, we also argue consistent with Banbury and Nahapiet (1979) that once a business has reached a critical size and uses a budget, size is unlikely to play a signi? cant further role in the determination of budgeting practice. Thus, our ? st hypothesis, expressed in the alternative, is: H1 . The adoption of written budgets by primary healthcare businesses is positively associated with business size. 4. 2. 2. Structure The structure of a business relates to â€Å"the formal speci? cation of roles for organisational members or tasks for groups to ensure that the activities of the organisation are carried out† (Chenhall, 2003). While two components, differentia tion and integration, have been identi? ed in the literature, we focus only on differentiation because of the small size of our sample businesses. Differentiation is de? ed as the extent to which managers act as quasi-owners and is achieved through decentralisation of authority (Lawrence and Lorsch, 1967). A centralised busi- 4 FTE urban GPs would receive $60,000 per annum from PIP (Medicare, 2009). R. King et al. / Management Accounting Research 21 (2010) 40–55 45 ness structure is characterised by decision-making that is restricted to owners and upper management whereas a decentralised business delegates decision-making to lower levels of management and operational staff. Given the closer links between the ownership and control of the business, ecision-making in centralised businesses should require relatively fewer MCS. Herein, existing evidence reveals centralised businesses as having relatively few administrative controls and less sophisticated budgets while decentralise d businesses have more formal controls (Bruns and Waterhouse, 1975; Merchant, 1981). We thus argue that structure has the potential to play a role in a business’s initial decision to adopt a budgeting practice, although we view its role as secondary to size since it is unlikely that the business’s ability to meet the ? ed costs associated with a budget practice will be directly related to its structure. Further, we argue that for small healthcare businesses that have reached the threshold size and use budgets, structure also has the potential to play a role in its subsequent decision as to the extent of use. As the business becomes more differentiated, decentralisation increases and thereby so does the need for formal MCS (Lawrence and Lorsch, 1967; Merchant, 1981). Our second hypothesis, expressed in two parts and in the alternative, is then:13 H2a . The adoption of written budget by primary healthcare businesses is positively associated with business structure (decentralisation). H2b . The extent of written budget use by primary healthcare businesses which opt to use written budgets is positively associated with business structure (decentralisation). 4. 2. 3. Strategy Business strategy, de? ned as how a business chooses to compete within its particular industry (Lang? eld-Smith, 1997), has been the focus of much of the research on MCS as opposed to corporate or operational strategy (Chenhall, 2003). While there are a number of different typologies of business strategy, we use Porter’s typology which focuses on cost leadership and product differentiation strategies. Porter’s cost leaders are characterised by competitive prices, consistent quality, ease of purchase, and a relatively restricted product selection. In contrast, differentiators offer the market something perceived as unique. Different types of MCS will be suited to different strategies due to their differing information and feedback requirements. Cost leadership strategies are argued to require speci? operating goals and budgets to facilitate cost containment at an operational level (Chenhall and Morris, 1995). Alternatively, product differentiator strategies would require more outward focussed, broadscope, MCS to collect infor- mation on competitors for planning purposes (Simons, 1987). Since primary healthcare businesses have constraints on the total number of services they can provide such as opening hours and the number of medical practitioners, a cost leadership strategy should require that tighter cost controls be in place in order to maintain overall pro? ability. In contrast, a product differentiator strategy operating with higher margins under the same constraints should require fewer controls. While we do not expect strategy to be determinative of the threshold decision to use budgets as it is unlikely to either affect the business’s ability to meet the initial ? xed costs or contribute suf? ciently to the business’s primary need for a budgeting practice, based on the arguments above we do expect it to impact on the desire to invest in marginal costs associated with a greater extent of budget use. Thus, formally, our third hypothesis, expressed in the alternative, is: H3 . For small healthcare businesses, which opt to use written budgets, those following a cost leadership strategy will use budgets to a greater extent than those following a product differentiation strategy. 4. 2. 4. Perceived environmental uncertainty (PEU) PEU is de? ned as a situation where managers perceive elements of the environment to be uncertain, with uncertainty distinguished from risk â€Å"as uncertainty de? nes situations in which probabilities are not attached† (Chenhall, 2003). In a general sense, PEU is seen to be an important contextual factor in the design of MCS because increased PEU makes managerial planning and control more dif? cult (Lawrence and Lorsch, 1967). PEU is, however, a general term and a number of researchers have provided more speci? c classi? cations of the environment (Waterhouse and Tiessen, 1978; Ouchi, 1979). In this study, we focus on the two most commonly researched elements of PEU, the dynamic nature of the environment (dynamism) and the level of competition (hostility). Contingency-based research in large business has found that greater dynamism is associated with a need for more externally focussed, broad scope and timely information (Chenhall and Morris, 1995). Planning becomes more dif? cult in more dynamic conditions as probabilities cannot as easily be attached to future events and controls such as static budgets may quickly become outdated. Thus, greater informal communication is required for effective decision-making and formal controls are less bene? cial or desirable (Chapman, 1997). Alternatively, large business research focussed n hostility has found that businesses facing greater competition rely on more formal controls and emphasise budgets (Khandwalla, 1972). Thus, in addition to con? rming PEU as an important contextual factor, these ? ndings also reveal the importance of specifying the dimension of interest (Chenhall, 2003). Consistent with the research on dynamism in large business but in contrast with that on hostility, Matthews an d Scott (1995) ? nd for small businesses, the sophistication of planning decreases with both increased dynamism and increased hostility. They argue from an economic perspective that for small businesses, the more uncertain 13 While it could be argued that it would be impractical for a small business consisting of a single medical practitioner and few administrative staff to have a decentralised structure, given the heavy demands of clinical work on the medical practitioner’s time, decentralisation is possible to the extent that operational and ? nancial decision-making is delegated to employees. This was con? rmed in discussions in the pilot study. 46 R. King et al. Management Accounting Research 21 (2010) 40–55 the environment the less likely the manager is to expend scarce resources on budgets with an unproven effect on performance. The rational manager trying to meet the fundamental goal of making a pro? t will weigh up the bene? ts against the costs associated with budgeting. Based on these arguments and ? ndings, we propose that as with strategy, neither dimension of PEU is likely to impact the mana ger’s threshold decision to adopt a budget as it does not directly impact on the ability to meet the costs. However, for businesses that have already identi? ed the need and ability to budget, both dynamism and hostility will impact on the decision to incur the added marginal costs of increased budget use. Consistent with Matthews and Scott (1995) and the large organisation literature, given the relatively small nature of our sample businesses and the likely resource constraints that they face, we predict a negative association between the PEU dimension of dynamism and the extent of use. 14 However, contrary to the large rganisation literature but consistent with Matthews and Scott (1995), we also predict a negative association between the PEU dimension of hostility and the extent of use. Our fourth hypothesis, expressed in the alternative, is then: H4 . The extent of written budget use by primary healthcare businesses which opt to use written budgets is negatively associated with the PEU elements of dynamism and hostility. 4. 3. Performance and budgets Budgets have been recommended for pl anning, monitoring, and controlling business activities, with each thought to assist businesses to achieve pro? ability (Horngren et al. , 2006). However, the effect of budgets on pro? tability has not as yet been clearly demonstrated in the literature (McMahon, 2001). There is evidence of a positive association between the use of budgets and performance as proxied by growth in small and medium enterprises (Gorton, 1999). Even without extensive empirical evidence, planning and the use of appropriate budgets are promoted by academics, educators and accounting practitioners as a means of enhancing ? ancial performance (Hansen and Otley, 2003; Gorton, 1999). Thus, we might expect that primary healthcare businesses using budgets experience better performance than those that do not. More carefully, according to ‘contingency-based’ research, a state of equilibrium in the relationship between the contingency factors and the type of MCS is best described by â€Å"? t† (C ovaleski et al. , 2003). â€Å"Fit† occurs when the organisation designs its practices in such a way that it has a positive impact on performance relative to alternative practices. Thus, there will be no universally effective ‘extent of budget use’, as each combination of contingency factors will â€Å"? t† with different practices. The positive impact on performance of attaining â€Å"? t† is due to the ef? ciencies that result from using the most suitable MCS. When there is a lesser â€Å"? t† between the extent of budget use and the contingency factors, performance will be â€Å"impaired†. Further, mis? t will be associated with lower performance irrespective of whether it arises from â€Å"over-budgeting† or â€Å"under-budgeting†. Thus, our ? th hypothesis, stated in the alternate form, is: H5 . A business’s performance is positively associated with the degree of ? t between the extent of budget use and its contingency factors. The inef? ciencies arise because the need for a budgeting practice is incongruent with the adopted practice. If the business over-commits to budgeting, it is likely to ha ve expended scarce human and ? nancial resources without enjoying commensurate bene? ts. Conversely, if it under-commits, its performance will likely suffer because of control and/or co-ordination problems. To illustrate, consider the various contextual factors identi? ed above. First, regarding size, a relatively small business that uses an extensive budgeting practice will have unnecessarily expended resources implementing and operating the practice when in fact informal communication is practical and likely preferred. Conversely, a relatively large business without a formal budgeting practice will likely ? nd both communication and co-ordination problematic given the complexity associated with a larger number of employees. In a similar fashion, a relatively centralised business with an extensive budgeting practice has likely expended resources on a level of control that is greater than required to encourage employees to make decisions that are in keeping with the organisational objectives. In terms of strategy, a cost leadership strategy requires more speci? c controls than a differentiation strategy. Thus, the adopted business strategy will likely be less effective if an incompatible budgeting practice is implemented to support the strategy. Finally, high levels of PEU make it much more dif? ult to plan with certainty, thereby reducing the need for and advantages of budgeting. Finally, notwithstanding equilibrium-type arguments, we believe that there will be variation in the degree of â€Å"? t† in our setting given the dif? culties that primary healthcare businesses likely face in identifying and implementing their best budgeting practices. Given their size and medical focus, it is likely that many of our sample businesses approach budgeting from a relatively unsophisticated perspective and/or view it as a lower priority. This makes the process of identifying a practice that â€Å"? s† relatively slow and involves ‘trial and error’ type of learning. Here, Luft (1997) argues that while static equilibrium theories â€Å"can predict the techniques the ? rm should end up with† they cannot predict â€Å"how long it will take to complete the process or what the path to the solution will be. † Thus, it is likely that there will be a lag between the need for and the use of a particular budgeting practice. Milgrom and Roberts (1992) also argue that organisations are dynamically learning and moving towards an optimal level of management accounting practice. The problem of implementing a budget practice that â€Å"? s† is further complicated by the fact that implementation of new budget practices is likely to 14 The variation in PEU of manag ers from different industries has typically been the focus of previous research. In this study, industry is a constant but arguably PEU is still of interest, as it has also been found to vary among the managers of businesses within the same industry (Boyd et al. , 1993). R. King et al. / Management Accounting Research 21 (2010) 40–55 47 occur in a â€Å"lumpy† fashion because when increasing the extent to which they use budgets, businesses are forced to do so in larger rather than smaller increments. As Luft (1997) argues, â€Å"changes in information systems are often sharply discontinuous†. 5. Method 5. 1. Sample frame and description For this study, a cross-sectional research design is used and the quantitative measurement tool is a mail questionnaire. Recognised problems associated with the implementation of survey-based studies include the initial dif? culty of identifying and accessing appropriate respondents, and then of achieving acceptable response rates (Dillman, 2000). In light of this, since budgets are considered to be a traditional management tool and there is an identi? d trend towards delegating management responsibilities to practice managers, practice managers were chosen as the target subjects for the survey (Department of Health and Ageing, 2005). The further problems of contacting practice managers via a cost effective means and encouraging participation were addressed by approaching the Australian Association of Practice Managers (AAPM) for support. T he AAPM is the only recognised professional body for practice managers in Australia and consists of managers of dental, medical, and allied health businesses. Currently, there are 1200 members of the AAPM from medical practices, representing approximately 6% of the small private medical businesses operating in Australia. Membership in the AAPM is voluntary subject to an annual subscription fee. There are a number of bene? ts associated with membership including discounts for management education courses and national conferences. Thus, it is likely that members of the AAPM are interested in staying informed about current management trends, wish to become part of a professional network, and have the means to pay the membership fee. While no demographic data currently exist for practice managers who join the AAPM and those who do not, member businesses appear slightly skewed towards larger practices relative to the population of GP businesses. For 2005–2006, 83% of GP businesses had between one and ? ve GPs, with the remaining 17% having six or more (PHCRIS, 2008). In comparison, for our sample practices, 66. 4% had between one and ? ve GP’s and the remaining 33. 6%, six or more. However, notwithstanding this potential bias, the advantages of accessing the AAPM practice manager mailing list and having the AAPM recommend participation are considered to dominate. The questionnaire was initially developed from the existing literature and then pilot tested on a sample of 20 members of the AAPM and ? ve academic researchers. Based on this testing, a number of changes were made to wording and layout to enhance understandability in this setting. The ? nal questionnaire consisted of 35 questions presented in 10 sections and was estimated to require between 20 and 30 min to complete. Questions relating to each of the relevant constructs discussed in Section 4 were presented in dedicated and clearly labelled sections. The ? nal questionnaire was sent to a random sample of 1000 of the medical practice members of the AAPM. Of the 1000 surveys distributed, 12 were returned unopened. From the remaining 988 questionnaires, 144 complete and usable responses were received, representing a 14. 6% response rate which is comparable with those achieved in other studies of small businesses (Dennis, 2003). 15 Requested demographic data reveal 112 of the practices to be GP practices and 32 to be specialist practices, and that they employed between 2 and 42 full-time equivalents (FTE). Further, 98. 6% indicate that they use computers in some capacity. The average age of the practices is 23. 94 years, and for the 114 organisations that responded to the question, their average gross fees were $1,553,919, ranging from $206,816 to $11,000,000. 5. 2. Budgeting practice 5. 2. 1. Empirical model The ? rst stage of this study seeks insights both into the factors underlying a business’s decision to adopt a budgeting practice and into its subsequent decision as to the extent of budget use. To do so, it appeals to contingencybased research to identify four contextual factors (size (SIZE), structure (STRUC), strategy (STRAT), and perceived environmental uncertainty (PEU)) argued to drive the decisions, although in different combinations. Given this framework, we employ the following common empirical model to formally examine each of these two decisions: BUDGi = + 1 lnSIZEi 0 + 2 STRUCi + 3 STRATi + 4 PEUi + 5 TYPEi +? (1) where the various measures are described below. For the decision to adopt, based on H1 and H2a , 1 and 2 are predicted to be positive. For the decision as to the extent of use, based on H2b , H3 , and H4 , 2 and 3 are predicted to be positive and 4 negative. Practice type (TYPE) has been included in the model to control for potential structural differences (Hair et al. , 2006). Speci? cally, identi? ed differences in the pricing (higher) and supply (lower) of services by specialist versus general practices suggest that the market for specialist services may be relatively more heterogeneous (Department of Health and Ageing, 2005). We measure TYPE as a dichotomous variable, set equal to 1 for general practices and 0 for specialist practices. . 2. 2. Dependent variable measurement To examine the decision to adopt, we measure BUDG as a dichotomous variable set equal to 1 if the business indicates, in response to an explicit ‘yes/no’ question, that it 15 The mailing was restricted to 1000 questionnaires due to ? nancial constraints. Standard techniques to discourage non-response were employed including a per sonalised cover letter from the AAPM, promised con? dentiality, brevity of questions, the inclusion of a reply-paid envelope, a follow-up e-mail reminder, and a promise to make results available to participants (Dillman, 2000). Testing for non-response bias, undertaken by comparing 15 responses received in the ? rst month to the ? nal 15 responses received, revealed no statistically signi? cant differences. 48 R. King et al. / Management Accounting Research 21 (2010) 40–55 uses a written budget and 0 otherwise. We base this analysis on all 144 respondents and run Eq. (1) as a logistic regression. For this and all subsequent analysis, reported p-values are one-tailed since we have predictions relating to each of the contingency factors. To examine the extent of budget use, we restrict our tests to the 65 respondents using written budgets. Here, the survey questionnaire asked respondents to indicate on a 5-point Likert scale how systematically their business used operating budgets of various durations (annual, halfyearly, quarterly, monthly, and/or weekly), as well as cash ? ow, ? exible, rolling, long-term, or other budgets. These questions capture both the types of budgets used and the extent of their use, and are an adaptation of the alternative measurement approaches used in Chenhall and Lang? eldSmith (1998) and Jankala (2005). 16 The Cronbach’s alpha is 93. 8%. Panel A of Table 1 presents descriptive statistics for the responses relating to the usage of each type f budget. To construct the ‘extent of budget use’ measure, we apply exploratory common factor analysis with orthogonal rotation to the responses. Two uncorrelated factors with eigenvalues of 3. 845 and 1. 234 are extracted, explaining 64. 14% of the total variance. The factor loadings are presented in the ? nal two columns of Panel A of Table 1. The ? rst factor aligns with operating budgets and the second with other types of budgets. As such, we consider two sub-categories (‘operating budgets’ and ‘other budgets’) and measure BUDG for each as the average summated budget usage score across the relevant budgets in the subcategory. 7 Here, Eq. (1) is run using OLS. Given a consistent lack of signi? cance, we do not report or discuss results based on our analyses of the ‘other budgets’ measure. 5. 2. 3. Contingency factor measurement Following the majority of contingency-based MCS studies, we measure size (SIZE) as the number of full-time equivalent (FTE) employees (Chenhall, 2003). Respondents were asked to identify the number of FTE employees as administrative/reception staff, practice manager, nursing/allied health, medical, and other. Table 2 reveals that the mean (median) number of FTE employees for our sample businesses is 11. 31 (10. 500). For sensitivity purposes, we a lternatively consider gross fees as a measure of size. Data on gross fees were provided by 114 of the businesses, with a mean (median) value of $1,553,919 ($1,322,359). For the remaining three contingency factors, the measures are based on responses across 7-point Likert scales to dedicated questions in the questionnaire survey. Panel B of Table 1 presents the questions and descriptive statistics for the responses. For STRUC and PEU which involve multiple questions, exploratory common factor analysis is then applied o develop the empirical measures. The factor loadings are presented in the ? nal two columns of Panel B. 18 In detail, the measure of structure (STRUC) is based on responses to six questionnaire items asking the extent to which decision-making authority has been delegated within the business and at which level operating decisions are made. The six items, originally developed by Gordon and Narayanan (1984), have been subjected to considerable scrutiny and empirical testin g for reliability and validity in previous research (Chenhall, 2003). The Cronbach alpha is 82. 7%. Application of exploratory common factor analysis to the response scores leads to the extraction of only one factor with an eigenvalue of 3. 261, explaining 53. 81% of the variance. Thus, STRUC is measured as the average summated scores across the six items. Organisational strategy (STRAT) is based on Porter’s classi? cation scheme (Porter, 1980) and measured by the response to a single question drawn from Govindarajan (1988). This question asks the respondents to indicate their belief as to the best description of the business’s strategic emphasis, ranging from product differentiation to cost leadership. This was found in the pilot testing to be the only question from previous research applicable to our setting, Finally, we initially measure perceived environmental uncertainty (PEU) based on the responses to nine questions developed by Gordon and Narayanan (1984) to capture the intensity of competition, the dynamic and unpredictable nature of the external environment, and the potential elements of change in the environment. Based on the correlations among the responses, only ? ve items were eventually used with a Cronbach alpha of 64. %, as the responses to four items had correlations of less than the 30% level recommended for inclusion in factor analysis (Hair et al. , 2006). 19 Consistent with previous research (Gordon and Narayanan, 1984), application of exploratory common factor analysis with orthogonal rotation led to the extraction of two factors with eigenvalues of 2. 327 and 1. 122 explaining 67. 70% of the total variance. Following the literature, we label these factors as à ¢â‚¬ËœPEU hostility’ (PEUhost ) and ‘PEU dynamism’ (PEUdyn ). PEUhost loads on the two questions relating to the competitiveness of the business environment whereas PEUdyn loads on the three questions relating to the predictability of the external environment. We include both in our empirical model, measuring each as the average summated response scores across the relevant questions. 16 Jankala (2005) prefers this measure of systematic use as a more reliable and precise measure of a business’s commitment to the use of budgets, rather than the more subjective scales used by, for example, Chenhall and Lang? eld-Smith (1998) that measure bene? t derived. 7 The yearly operating budgets did not load on either factor as a large majority of the businesses indicated that they used yearly operating budgets on a systematic basis. 18 The reported factor loadings, eigenvalues, and percentage variation explained are based on the full sample of 144 respondents. When the exploratory common factor analysis is repeated based only on the 65 respondent bus inesses using budgets, all measures are qualitatively identical. 19 The four items removed were competition for manpower, new services marketed, ability to predict preferences for customers, and change in legal, political, and economic environment. Their removal is perhaps not surprising that as there was little variation in the responses received with the sample small businesses drawn from the same industry. R. King et al. / Management Accounting Research 21 (2010) 40–55 Table 1 Descriptive statistics and factor loadings for survey questionnaire responses. Question Descriptive statistics Mean Panel A: Budgeting BUDG 1 Which of the following budgets are prepared and how consistently? (5-point scale: 1 = not used, 2 = seldom, 3 = at times, 4 = often, 5 = systematically) a. Operating budget, yearly b. Operating budget, half-yearly c. Operating budget, quarterly d. Operating budget, monthly e. Operating budget, weekly f. Cash ? ow budget g. Flexible budget h. Rolling budget i. Long-term budget Med SD Factor loadings #1 #2 49 2. 690 2. 064 2. 064 2. 092 1. 578 2. 079 1. 701 1. 704 1. 795 1 1 1 1 1 1 1 1 1 1. 899 1. 663 1. 659 1. 662 1. 315 1. 626 1. 317 1. 400 1. 473 0. 746 0. 614 0. 533 0. 668 0. 472 0. 149 0. 317 0. 168 0. 255 0. 322 0. 034 0. 346 0. 508 0. 823 0. 606 0. 715 Panel B: Contingency factors Structure (STRUC) STRUC 1 To what extent has authority been delegated to the manager or employee for each of the following decisions? Please indicate actual rather than stated authority) (7-point scale: 1 = no delegation, 7 = total delegation) a. Initiate ideas for new services b. Hiring and ? ring of personnel c. Selection of large investments d. Budget allocations e. Pricing decisions STRUC 2 Most operation decisions are made at what level? (7-point scale: 1 = owner level, 7 = manager level) 4. 999 5. 250 3. 173 3. 980 4. 311 4. 349 5 6 3 5 5 4 1. 517 1. 923 1. 963 2. 123 1. 900 1. 870 0. 531 0. 610 0. 732 0. 803 0. 761 0. 581 – – – – – – How would you best describe your practice’s strategic emphasis? 7-point scale: 1 = product differentiation; 7 = cost leadership) Perceived environmental uncertainty (PEU) PEU 1 How stable/dynamic is the external environment (economic and technological) facing your practice? (7-point scale: 1 = very stable, 7 = very dynamic) a. Economic environment b. Technological environment PEU 2 How would you classify the market activities of your competitors (i. e. , other healthcare practices) in the past 3 years? (7-point scale: 1 = becoming more predictable, 7 = becoming less predictable) How intense is each of the following in your industry, the healthcare profession? 7-point scale: 1 = negligible, 7 = intense) a. Bidding for purchases b. Price competition Strategy (STRAT) STRAT 1 2. 983 3 1. 127 n/a n/a 4. 134 4. 7 61 3. 691 4 5 4 1. 603 1. 596 1. 122 0. 968 0. 755 0. 369 0. 176 0. 185 0. 118 PEU 3 2. 446 3. 553 2 4 1. 352 1. 502 0. 147 0. 168 0. 676 0. 625 Panel C: Performance (PERF) PERF 1 Which best describes your response to the following statements over the past 3-year period? Compared to key competitors, my practice: (7-point scale: 1 = strongly disagree, 7 = strongly agree) a. Is more competitive b. Has more patients c. Is growing faster d. Is more pro? table e. Is more innovative f. Has more doctors 5. 082 5. 353 5. 105 5. 210 5. 320 4. 094 5 6 5 5 6 4 1. 607 1. 619 1. 644 1. 593 1. 643 2. 204 0. 660 0. 711 0. 849 0. 667 0. 592 0. 502 – – – – – For Panel A, the exploratory factor analysis was conducted based on the 65 businesses that produce written budgets. For Panels B and C, the exploratory common factor analysis was based on the full sample of 144 respondents. Items deemed to load on the identi? ed factor appear in bold. 50 R. King et al. / Management Accounting Research 21 (2010) 40–55 Table 2 Descriptive statistics for ‘contingency-based’ model variables. Measure ‘Operating budgets’ Mean Median Standard deviation Min max Size (SIZE) Mean Median Standard deviation Min max Structure (STRUCT) Mean Median Standard deviation Min max Strategy (STRAT) Mean Median Standard deviation Min max PEUhost Mean Median Standard deviation Min max PEUdyn Mean Median Standard deviation Min max Performance (PERF) Mean Median Standard deviation Min max Full sample (n = 144) 1. 948 1. 000 1. 376 15 11. 531 10. 500 6. 583 2 42 4. 344 4. 333 1. 381 17 1. 990 2. 000 1. 122 17 2. 987 3. 000 1. 199 16 4. 201 4. 333 1. 179 1 6. 6 4. 027 4. 083 1. 248 17 Written budget (n = 65) 3. 085 3. 000 1. 50 15 12. 893 12. 000 6. 367 3. 5 31 4. 862 5. 000 1. 212 1. 67 6. 83 1. 860 2. 000 1. 014 16 3. 231 3. 000 1. 183 16 4. 241 4. 333 1. 129 1 6. 67 4. 228 4. 333 1. 302 17 No written budget (n = 79) n/a p-Value – 10. 410 9. 250 6. 586 2 42 3. 918 3. 833 1. 372 17 2. 090 2. 000 1. 200 17 2. 785 2. 500 1. 181 1 5. 5 4. 169 4. 333 1. 224 1 6. 67 3. 861 3. 833 1. 184 1 6. 5 0. 024 0) or â€Å"under-budgets† (? 0), the impact of ‘lack of ? t’ on ? nancial performance should be the same. Formally, the model we employ, illustrated using |? |, has the following form: PERFi = 0 we also requested objective measures of pro? ability from our sample businesses (Govindarajan and Gupta, 1985). Unfortunately, less than one-third of our sample provided the data. Thus, the use of objective measures for robustness purposes is also impractical. 6. Results and analysis 6. 1. Preliminaries Descriptive statistics for measures used in tests of our hypotheses are presented in Table 2, both for the overall sample of 144 respondents and for the sample partitioned on the basis of whether a written budget is adopted, along with tests for differences in mean values between partitions. As revealed, there is considerable cross-sectional variation in each measure. Further, there appear to be several signi? cant differences between respondents adopting written budgets and those not. Speci? cally, businesses using budgets have more FTE employees (SIZE, p = 0. 024), are more decentralised (STRUC, p 0. 001), face a more hostile enviro How to cite Budgeting Practices and Performance in Small Healthcare Businesses, Papers