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7. Tratamiento del Linfoma Hodgkin

7.1 Tratamiento del Linfoma Hodgkin clásico

7.1.2 Enfermedad extendida

It is difficult to detach completely internal factors from external triggers of change since decisions that appear on the surface as internal might be responses to some external incident or in some way fit with the organization‟s strategy which is designed to respond to external pressures (Cinquini and Tenucci 2010; Senior and Swailes 2010). This reflects the concept of the organization as an open system operating in multi-demensional environments. As a consequence, Winter and Nelson (1982) and Burns and Scapens (2000) confirm that “studying the processes of MAC requires a conceptualization of the ways in which new accounting practices evolve over time” (see Burns and Scapens 2000:4). In the same way,

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Dawson (1994) reveals that it is necessary to understand processes of change within an organization; and he states also:

“Although there is a growing body of literature in the area of strategic change, a gap remains for the development of a new theoretical framework for understanding major organizational transition at the operational level” (1994:12).

Similarly, Pettigrew argues that,

“There are remarkably few studies that actually allow the change process to reveal itself in any kind of substantially temporal or contextual manner. Where the change is treated as the unit of analysis, the focus is on a single event or a set of discrete episodes somehow separate from the immediate and more distant antecedents that give those events form, meaning, and substance. Such episodic views of change not only treat innovations as if they had a clear beginning and a clear end but also, where they limit themselves to snapshot time-series data, fail to provide data on the mechanisms and processes through which changes are created [as we explained in planned approach]. Studies of transformation are, therefore, often preoccupied with the intricacies of narrow changes rather than the holistic and dynamic analysis of changing” (1990:269).

The proposition that is possible here in response to the above limitations in the MA literature suggests that the form of the research should be contextualist and/or processual in character (Pettigrew 1985a; 1985b). Thus, Pettigrew writes:

“A contextualist analysis of a process such as change draws on phenomena at vertical and horizontal levels of analysis and the interconnections between those levels through time. The vertical level refers to the interdependences between higher or lower levels of analysis upon phenomena to be explained at some further level; for example, the impact of a changing socioeconomic context on features of intraorganizational context and interest-group behaviour. The horizontal level refers to the sequential interconnectedness among phenomena in historical, present, and future time. An approach that offers both multilevel or vertical analysis and processual, or horizontal, analysis is said to be contextualist in character” (1990:269).

The rationale for choosing contextual analysis, including a processual approach, stems from the principle that MAC cannot be and should not be static, or a series of linear incidents over a specific time period; rather, it is seen as an on-going process (Burnes 1996). In support of this argument, Scapens (2006) states that its not easy to understand MAPs without understanding the organizational context. Otley (1980) criticizes research based on armchair theorizing without drawing on pragmatic data. Kaplan (1998) states that there is a need to describe the problems and factors associated with new MAPs, such as BSC & ABC. Ryan et al. (2002) show that the knowledge of determinants of change will enable managers to design MASs that conform with the characteristics of their organization. As a result, Van de Ven and Huber (1990:213) state that there has been a growing interest in recent years in studying the following question: “How does an organizational change emerge, develop, grow or terminate

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Dawson (1994; 2003) views MAC as a phase of organizational change described by unpredictable events, confusion and disruption that occur within a certain period of time. Thereby, the interpretation of MAC as a view of action according to a contextual approach is problematic. Individual and organizational behavior cannot be predicted a priori by either actors‟ attentions or environmental conditions (Pfeffer 1982). Thus, Pettigrew (1987) argues that any contextualist analysis of change should have the following characteristics: Firstly, it must be clearly defined although it may be theoretically and empirically connected with a set of levels of analysis; secondly, it also requires a clear description of the process or processes of change, so it must adopt sound theory (e.g. institutional theory) that takes into consideration “the history and future of a system and relate[s] them to the present”; thirdly, the processual approach requires a motor, or theory,12 to drive the process, part of which requires the design of the model of human beings underlying the study; finally, it is crucial for this whole approach of contextualist analysis that the contextual variables in the vertical analysis are correlated to the processes under observation in the horizontal analysis. This means that the use of this approach does not treat context either just as descriptive background or as an assorted list of antecedents that somehow shape the process. But it is necessary to explain the processes of change as an interpretive case-study over a period of time.

Contextual analysis of change has been established to be less prescriptive and more analytical. It can provide a holistic understanding of the factors in and barriers to managing change within a complex environment. Hence it does not use a particular theoretical insight (Dawson 1994; 2003)13. In the same view, Pettigrew (1987) suggests that the starting point of contextual analysis of change is the belief that formulating the content of any new system certainly entails managing its context and process. External context refers to the social, political, economic and competitive environment in which the organization operates; internal

12 Within this study on management accounting change, which adopts Burns & Scapens‟ framework as a starting

point of analysis, the emphasis is placed both on people's capacity and desire to adjust social conditions to meet new ways of working and on the part played by power relationships in the mobilization and continuous development of the processes being examined.

13 Dawson used a framework to analyze the processes of organizational change by depending on three

timeframes, i.e. the beginning time of a need to change, the time of organizational transition, and the process of the new systems and practices. Also, he classified the change determinants into three main groups: (1) substance of change which represents the introduction and use of new systems or technologies; (2) politics of change which represents the activity of consultation, negotiation, conflict and resistance; and (3) context of change which refers to the past and present of extra- and intra-organizational factors and future expectations and projections. Thus, he used these classifications to be compatible with the three timeframes. At the same time, this approach is based on the work of Pettigrew, who is also not using any specific theoretical framework in investigating the processes of organizational change (see Dawson 1994).

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context refers to the organizational structure, culture, power and politics context within an organization through which initiatives for change must be introduced. Content refers to certain areas of change under examination. Thus the organization can be seeking to change information technology, human resources system, customer orientation, MAPs, organizational structure, or indeed organizational culture (ibid). The process of change refers to the actions, institutions, routines, reactions, and interactions of the various organizational actors as they seek to change the organizational systems and practices (ibid). Consequently, the literature of change is largely discussing the „what‟ of change briefly under the label of „content‟, while a great deal of the „why‟ of change is derived from an analysis of internal and external context, and the „how‟ of change may be conceptualized from an analysis of processes (ibid. and see also Pettigrew 1997).

The processual approach has significant implications for both researchers and practitioners of management accounting. Particularly through understanding the dynamics of processes of change (organization-specific), managers will be better able to impact on the route of change programmes within their own organizations, in addition to anticipating potential difficulties along the way. However, this approach focuses primarily on the factors of change at an intra- organizational level; extra-organizational dynamics of change are ignored. Indeed, the contextual approach has a holistic view to clarify how extra-organizational events are central to catalyzing the processes of MAC which consequently unfold in the organization. Moreover, contextual studies tease out not only the features of change through time, but also the continuity of settled patterns of behavior (Burns 2000).

The study of processes or dynamics of MAC, generally through longitudinal case-studies, has also been suggested by a number of scholars in the literature (Hopwood 1990; Burns 2000; Burns and Scapens 2000; Soin et al. 2002). They point out that little is known about the processes of MAC either in terms of the forces which influence MAC and shape different types of accounting systems, or the outcomes of such change. The aim of adopting a contextual approach is to explain beyond simplified, „rational‟ MA configurations, and to draw the dynamics which guide outcomes but which cannot always be anticipated and which may come unexpectedly (Burnes 1996). Thus, contextualists always believe that culture, power and politics play a key role in the process of organizational change.

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The assumption of the contextual approach developed by Pettigrew and Dawson is compatible with the assumptions of both the OIE and NIS that are adopted in this study (see figure 2-6). The contextual approach is a more comprehensive concept than the processual approach; at the same time, the processual approach is the principal component of contextual analysis. While the assumptions of processual analysis are the same as OIE assumptions, both seek to explain processes of MAC within a specific organization at a micro level. However, a processual approach is not enough to consider the effect of external factors and internal constraints on change (e.g. power and politics). To avoid the shortcomings of the processual approach, the study adopts a contextual approach to provide a holistic view of processes of MAC at multi-levels. Thereby, the study adopts Burns and Scapens‟ institutional framework to conceptualize MAC inside the organization at the micro level (Burns and Scapens 2000), and Dillard et al‟s (2004) model to explore the processes of change outside the organization at both societal and macro-context levels (Dillard et al. 2004). In additon, the study has paid attention to the role of power and politics factors in the processes of change. These are used to enrich and explain MAC as an interpretive case-study within the Jordanian Customs Organization after the introduction of NPM ideas.

Figure (2-6) Contextual Analysis of MAC as Open System

(Source: Author)

Contextual analysis in the above figure shows multi-levels of analysis including vertical analysis and processual or horizontal analysis for understanding MAC. Hence, the processual approach is seen as part of contextual analysis (Van de Ven and Huber 1990). While the

Power and Politics Mobilization is at the heart of Contextual Approach Processual Approach is

equivalent with B&S Framework Inspired OIE

Theory

Contextual Approach is equivalent with Dillard

et al. Model Inspired NIS Theory

Societal Level

Macro Level

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processual approach explains MAC only inside the organization by drawing on OIE theory; the contextual approach explains MAC both inside the organization by drawing on OIE theory (processual approach) and outside the organization by drawing on NIE theory. However, little attention has been paid specifically to understanding and explaining why and how accounting systems emerge in the manner they do, at given times, and within specific organizational contexts. Such an approach would supplement the increasing number of “contextualist” or “processual” studies of broader characteristics of organizational life (Burns 2000; Scapens and Burns 2000; Burns and Baldvinsdottir 2005), especially by studying MAC within interpretive case-studies (Pettigrew 1990; Dawson 1994). Consequently, there has been a significant increase over the last decade in research that considers context as paramount, and that explains MAC as a process rather than a snapshot analysis of change outcomes (Dawson 1994; Burns 2000; Burns and Scapens 2000; Burns and Vaivio 2001). Accordingly, the following section explains the relationship between management accounting change and NPM doctrine as alternative paradigm to public financial management.