Melco Management Accounting Research
Discussion Paper Series
No.MDP2018-005
Decision making by top managers of nonprofits in a financial crisis:
The role of accounting information

October 2018

Yoshitaka Shirinashihama
Associate Professor, Yamagata University, Faculty of Humanities and Social Sciences
1-4-12 Kojirakawa-machi, Yamagata City, 990-8560, Japane-mail: snh@human.kj.yamagata-u.ac.jp

The Melco Foundation
Nagoya, Japan
Discussion Paper Series of the Melco Management Accounting Research, in order to promote
the study of management accounting, has published this unfinished paper onto the Web. Pleaseobtain the permission of the author when citing this paper.

Decision making by top managers of nonprofits in a financial crisis:
The role of accounting information
Yoshitaka Shirinashihama
Yamagata University

Abstract
The decisions of top managers of nonprofit organizations during a financial crisis have asignificant influence on the organization. However, prior studies of nonprofit
organizations during a crisis focus mainly on the effect of changes in management
accounting systems. This study aims to reveal the managers’ decision-making process,their use of accounting information, and their response the conflict between profitability
and the organization’s mission. Our survey of Japanese nonprofit nursing homes
indicates the managers’ responses to a financial crisis. We also interviewed several
survey respondents and find that they made decisions within their mission domain anduse accounting information positively. However, nonprofit managers facing financial
difficulties rarely introduce or change their management accounting systems.

Keywords: nonprofit organizations, decision making, financial crisis, critical decision
method (CDM)

11. Introduction
Researchers in the past few decades investigated the use of management
accounting in nonprofit organizations under financial pressure. When top managers of
nonprofits face serious financial problems, they must determine restructuring plans to
get out of the difficult situation. This includes improving the profitability of theirservices, suspending or abolishing unprofitable business, starting a new profitablebusiness, and introducing or revising management accounting systems. On the other
hand, nonprofit organizations must also consider their organizational mission, which
may conflict with the restructuring plan (Maier, Meyer, & Steinbereithner, 2016). In
addition, members of nonprofit organizations consist of professionals such as physicians,
nurses, and so on, who sometimes resist the restructuring plan (Collier, 2001, Broadbent,
Jacobs, & Laughlin, 2001, Jacobs, 1998, Lehtonen, 2007, Marriott, Mellett, &Macniven, 2011). These factors mean that top managers of nonprofits may have to makedifficult decisions under financial pressure.
This study investigates the decision making process of the top managers of
nonprofit organizations under financial pressure and their use of accounting information.
In general, top managers’ judgements and decisions have a significant effect on theirresults (Hambrick & Mason, 1984, Hambrick, 2007). Despite this influence, studies ofthe decision-making process of top managers of nonprofits under financial pressure are
relatively scarce. Thus, our study aims to fill a considerable research gap.
We collected data from nonprofit organizations (syakaifukusihoujin) that run
nursing homes for elderly people in Japan. Japan has a long-term care insurance system,
in which the central government sets most prices for insured services.1 The prices of
insured services have been decreasing in recent years.2 In addition, the workforce
shortage is worsening, and some nursing homes cannot operate fully. These factors
increase the seriousness of the financial conditions at nursing homes. Thus, Japanese
nonprofit elderly care service providers are one of the most appropriate research targets.
This research has several contributions. First, by using cognitive task analysis,
especially the critical decision method (CDM), we reveal the detailed decision-making
process of nonprofit managers during a financial crisis. CDM is one of the most1

Care service providers set the prices of uninsured services, such as meal and residence

expenses.
2

In Japan, the prices of insured elderly care services are revised every three years.
2

appropriate methods to research the cognitive process of experts in critical situations(Crandall, Klein, & Hoffman, 2006). To the best of our knowledge, no prior accounting
studies use CDM, and we show the applicability of this method in accounting research.
In addition, the results have implications for managers of nonprofit organizations
because it highlights important aspects of decision making in financial crises. In
difficult situations, managers of nonprofits must consider several aspects ofrestructuring plans simultaneously.
In the next section, we provide background information about Japanese nonprofit
nursing homes. We then review the literature and present the research questions. Section
4 describes the research methods, questionnaire survey, and CDM. In Section 5, we
present and discuss the survey and interview results. Finally, Section 6 concludes andsuggests future research topics.

2. Japanese nonprofit nursing homes
Japanese nonprofit nursing homes face a severe competitive environment. The
long-term care insurance system began in 2000. As a form of social insurance, clients
pay an insurance fee and the central, prefecture, and municipal governments provide
financial support. However, the increase in the elderly population created financial
problems within these governments.
After 2000, for-profit service providers joined the elderly care service industry,
while the the number of nonprofit care providers also increased, which intensified thecompetition among nonprofit and for-profit service providers. In addition, the Japanese
government decreased the prices for insured elderly care services to control the rapidly
increasing payments from the government to fund the system. For example, the prices
for special nursing homes, which are operated mainly by nonprofit organizations(syakaifukusihoujin), were revised in 2015, and the average prices decreased by 5.6
percent.
The workforce shortage also worsened the financial conditions of nonprofit
nursing homes. Care homes must employ a certain number of care workers to provide
insured care services in their facilities to meet the requirements. For example, nursing
homes with a capacity of it is 90 beds must employ 30 full-time equivalent (FTE) care
workers, 3 FTE nurses, and other professional medical employees to be in full3

operation.3 If they cannot meet the required standards, they cannot be in full operation.
Thus, their organization’s revenue will decrease. In recent years, the number of care
workers in Japan decreased dramatically for several reasons, such as the low salary andhigh work load.
Nursing homes in the Tohoku region in Japan endured the 2011 Tohoku
earthquake and tsunami, which destroyed some facilities and equipment, and in whichsome patients and care workers died. After this disaster, the region’s population
decreased dramatically. The nonprofit nursing homes aiming to provide care services inthis harsh environment faced significant financial difficulties.
In summary, intensive competition among care service providers, price revisions
for insured services, and the workforce shortage caused financial difficulties in
nonprofit nursing homes. In the Tohoku region, the earthquake and tsunami had a fatal
effect on the financial condition of nursing homes.

3. Literature review and research questions
How do nonprofit organizations facing financial difficulties make decisions anduse accounting information in their decisions? Nonprofit organizations have objectives
besides making profit; that is, they aim to provide mission-related services (Anthony &Young, 2003, Weisbrod, 1998). This characteristic makes judgements and decisions in afinancial crisis difficult. Top managers may determine a restructuring plan, in which
they will create a profitability improvement plan and estimate the effect of that plan on
their financial performance. In extreme cases, they may shut down or stop their
mission-related services, or launch new profitable, but not mission-related, services.
They may also use accounting information to determine plan and introduce or change
their management accounting systems to improve their financial condition.
Top managers of nonprofits with an excessive focus on financial conditions cancreate mission drift (Maier et al., 2016), meaning that the organizations do not focus on
their mission and either do not provide or reduce mission-related services. In suchdecisions, top managers may have to consider their mission and financial conditions
simultaneously. Sometimes, mission-related services are unprofitable (Weisbrod, 1998),
so top managers may reduce these services and increase the number of profitable
3

The Ministry of Health, Labor and Welfare set personnel, facilities, and operational

standards for each insured care service type.
4

services.
Research into how managers deal with this situation and use accounting
information in their decision-making process is scarce. For example, Carlsson-Wall,
Kraus, and Lind (2011) describe the change in budgetary control systems in a public
home help unit facing financial crises in Finland, though they do not address thedecision-making process. Abernethy and Chua’s (1996) longitudinal case study shows
the process behind the change in control package and includes a short description of the
new CEO’s crisis management, but does not explain the decision-making process anduse of accounting information.
Few studies examined this topic, though the decision making of nonprofit
managers in financial crises have a significant impact on their organizations. Thus, we
aim to fill this research gap by addressing the following research questions:
RQ1: In their decision-making process, how do top managers of nonprofits use
accounting information in a financial crisis?
RQ2: How do top managers of nonprofits deal with the conflict between financial
problems and mission related activities?

4. Research methods
To investigate the research questions, we conducted a (1) questionnaire survey of
nonprofit nursing homes, and then (2) interviewed some respondents who addressedfinancial problems. We used mixed methods research (Creswell & Clark, 2007) toreveal the detailed decision-making process in financial difficulties.

4.1. Questionnaire survey
We submitted a prototype questionnaire to academic researchers who study
accounting in hospitals or the social service industry for a pilot test and revised ourquestionnaire based on their comments. We sent the revised questionnaires to top
managers of nonprofit nursing homes in the Tohoku Region of Japan. Given the severe
competitive environment for Japanese nonprofit nursing homes, we expect many top
managers facing financial difficulties to respond to our survey. We made a list of
nonprofit organizations (shakaifukusihoujin) operating nursing homes from data
available from the web sites of prefecture governments. In the summer of 2016, we sent
questionnaires to 515 nonprofit organizations, and received responses from 174 top
5managers, a response rate of 33.8%.
We based our questionnaire on previous studies and our knowledge of nonprofit
nursing home management. The questionnaire had two parts.4 First, we researchedbudgetary control intensity. Prior studies show that organizations change their budgetarycontrol systems to improve their financial condition (Carlsson-Wall et al., 2011), so we
focused on this management accounting system. The scale included items related to (1)organizational units of budgetary control, (2) frequency of budgetary control, and (3)detail of profitability management to evaluate different aspects of budgetary control.
Second, we researched significant financial crises and responses. This section
included free-form description type questions related to (1) significant theorganization’s financial crises in top managers’ experience and (2) top managers’
responses to these crises. We used these questions to collect a significant amount of
information about actual experience and managers’ responses to significant financial
crises.

4.2. Interviews: Critical decision method
We requested interviews with survey respondents with experience of significant
financial crises. Seven top managers accepted our request. In our interviews, we used
CDM to reveal the detailed process of decision-making (Crandall et al., 2006; Klein,
Calderwood, & Macgregor, 1989).
CDM is a cognitive task analysis method that aims to reveal decision making
processes in challenging situations (Crandall et al., 2006). For example, prior studies
use this method to study diagnoses and responses to neonatal sepsis in a neonatal
intensive care unit (Crandall & Getchell-Reiter, 1993), firefighters’ judgements during
large scale fires, and weather forecasters’ judgements before a hurricane. Researchers
can use the information collected via CDM to develop educational and training
programs.
CDM consists of four steps: selecting an incident, constructing a timeline,
deepening, and “what if” queries (Crandall et al., 2006). In the first step, we asked the4

The questionnaire has other parts related the organization’s goal, frequency ofmanagement meetings, and so on. We do not report these results because they are notrelated our research questions.
6interviewee for an overview of a possible difficult situation and to identify anappropriate situation for analysis. In step 2, we asked the interviewee about thesequence of events and constructed a timeline. We can separate this timeline into several
parts based on changes in the interviewee’s understanding of a situation and someactions that affected the situation. In step 3, based on the phases of the situation, we
deepened our understanding of the interviewees’ judgment and decisions. We asked
some questions repeatedly, such as “how do you get the information,” “how do you
notice the information,” “what is the basis of your judgement,” “what is the image you
describe in your mind,” and so on. By doing this, we can reveal the interviewee’s
judgment and decision making. In step 4, we asked the interviewee “what if” questions
and investigated other possibilities related to their judgement and decision making,possibly revealing mistakes by inexperienced managers or the critical information that
affects their judgement and decision making. We recorded and transcribed ourinterviews.

5. Results and discussion
5.1. Questionnaire survey results
We analyzed the 147 responses for all question items, which included 43
responses from top managers who experienced a significant financial crisis and 103
other responses. We compared the responses from these two groups.
Table 1 shows the differences in budgetary control between these groups ofmanagers. We find little difference in budgetary control, suggesting that nonprofit
nursing homes did not change their budgetary control systems, even in the event of asignificant financial crisis. This is not much of a surprise; prior studies of theintroduction or change in management accounting systems at nonprofit organizations
that face financial difficulties find similar results (Abernethy & Chua, 1996,
Carlsson-Wall et al., 2011). We later considered the cause of this result using theinterview results.

7

Table 1 Differences in budgetary control between organizations that did and did
not experience a financial crisis
crisis experienced

others

n=43

n=103

χ

Business unit

100%

100%

NA

NA

Department in business unit

25.6%

35.6%

0.96

0.326

8.45

0.133

Weekly0%

2.9%Monthly

65.1%

77.9%

Bimonthly

7.0%

1.0%

Quarterly

20.9%

10.6%

Semiannually

4.7%

5.8%

2.3%

1.9%
5.06

0.282

2

p value

Organizational units of budgetary controls

Frequency of budgetary control
Business unit

Annuallyab

Department in business unit
Monthly

63.6%

64.9%

Bimonthly

9.1%

0%

Quarterly

18.2%

10.8%

Semiannually

9.1%

13.5%

Annually

0%

10.8%

Organizatonal level

72.1%

75.0%

0.03

0.874

Business unit level

88.4%

87.5%

0.00

1.000

Departement in business unit level

14.0%

21.2%

0.61

0.435

Service user level

9.3%

3.8%

0.86

0.354

Detail of profitability management(multiple answers)aIncludes responses from only top managers who responded that they use a budget department for control. Sample

size of "crisis experienced" is 11, and "others" is 37.
b

The Fisher's exact test results were also non-significant.

Regarding the causes of significant financial crises in Table 2, many top managers
pointed to the decrease in the prices set by the central government. Some managers
reported that the workforce shortage, decrease in users / bed occupancy rates, anddecrease in service prices combined worsened the financial condition of their nonprofit
nursing homes. Other managers identified the large effect of new investment on their8financial conditions, stating that due to the price decrease and/or workforce shortage,
they were not able to earn the initially expected surplus.
Table 2 Causes of significant financial crises in nonprofit nursing homes
Cause of finanical crisis
Rise of labor costs

14.0%

Shortage of workforce

14.0%

Less cash inflow of new facility/equipment than expected

14.0%

Decrease of service prices by Central Government

44.2%

Decrease of service users /bed ocupancy rate

14.0%

Other reason

16.3%

Top managers responded to financial crises in several ways. The most popular
was to plan and implement methods to increase users (23.3%), which would increase
revenue. Other ways to increase revenue included providing more nursing care (14.0%).
In long-term care insurance systems, when organizations meet some care provision
standards, they can receive a higher payment. These two methods to increase revenue
requires an appropriate workforce. Thus, some top managers responded that recruiting
care workers and improving labor conditions (16.3%) should increase revenue.

9

Table 3 Top managers’ responses to financial crisesa
Responses to financial crisis
Planning and impementing of the way to

23.3%

increase users
Review of expenditures to general and

16.3%

administrative costs
Recruting care workers and improvement

16.3%

of labor conditions
Getting additonal amount for nursing care

14.0%

Borrowing money form banks

11.6%

Shut down or stop of unprofitable services

9.3%

Meeting with other mangaers and making

7.0%

restructuring plan
Limiting increase of salarly

7.0%

Others41.9%

aIncludes responses indicating that more than three managers

implemented these measures.

Some top managers implemented cost reduction plans. They reviewed theirgeneral and administrative expenses and reduced some of them (16.3%), ended
unprofitable services (9.3%), and limited salary increases (7.0%).
When top managers had to rebuild their business, they met with other top
managers and outlined a restructuring plan (7.0%). Implementing restructuring plans
requires significant funding, and when nonprofits face financial difficulties, they often
lack the money to do so. Thus, 11.6% of responding managers indicated that theirnonprofits borrowed money from banks.
Only one top manager responded that he (or her) enhanced their management
accounting system. Again, the questionnaire results suggest that top managers in
nonprofit nursing homes in Japan do not focus on introducing or changing management
accounting systems.
While we have information from top managers of nonprofits about responses tofinancial crises, we do not know how they use accounting information in their decision
making. We next discuss the results of the interviews with seven respondents and theirdecision-making process.

10

5.2. Interview results
5.2.1. Use of accounting information
We analyzed our CDM interview results and identified managers’ use ofmanagement accounting information in their judgements and decision making during afinancial crisis (Appendix). Managers use accounting information to enhance
profitability in two ways by (1) increasing their workforce and (2) initiating new
business.
First, they use accounting information when increasing their workforces byfocusing on increasing their fees for nursing care. The Japanese long-term careinsurance system sets some additional fees for some services when service providers
establish high-quality services. For example, additional payments to enhance the service
delivery system type I requires that service providers meet some criteria, one of which
is a sufficient number of care workers, half with national qualifications for certified care.
The provisions are revised every three years. Thus, top managers who experienced
financial difficulties frequently checked revisions to the criteria and estimated the effectof higher fees on the profitability of their business. Of course, enhancing the service
delivery system needs additional employees. They drafted plans to increase labor
expenses and revenue, and decided whether to do so or not before the price revisions for
insured care services.
Second, managers aiming to restructure their business by introducing new
profitable business use accounting information. Some top managers experienced the2011 earthquake and tsunami in the Tohoku region, and had to reconstruct their facilities
and equipment to provide services. Unlike increasing the number of care workers, this
response required managers to make judgements and decisions based on incomplete
information and time pressure. In this process, managers mainly estimated the cash flowof their investment. However, time pressure sometimes had a greater effect on theirdecision making than did accounting information. For example, the central government
planned to establish some subsidies to reconstruct nursing home facilities andequipment. However, the national congress took a long time in their discussions, andtop manager C could not predict when the subsidy system would start. Top manager C
wanted to use this subsidy, but he had to reconstruct the facilities as soon as possible.
The tsunami damaged many facilities, and service users and care workers used anotherorganization’s facility temporally. Thus, they could not increase the number of users,
even if one died. Therefore, the longer the reconstruction took, the higher was theopportunity cost. Thus, top manager C gave up using subsidies for reconstruction, and11

decided that the nonprofit would rebuild on their own. However, he said that looking
back, he would wait for the subsidy. Other organizations that used subsidies completed
their reconstruction before his organization did. This case suggests that in a significant
financial crisis, time pressure has a greater effect on top managers’ decision making
than accounting information does.

5.2.2. Mission-profitability conflicts
Did managers experience conflicts between the organizational mission andprofitability? In our interviews, top managers did not identify conflicts between the
mission and profitability. The mission defined their business domain (Simons, 1995),
and they planed their restructuring accordingly.
For example, top manager E said that their nonprofit’s mission is to contribute tocommunity residents’ welfare. Some community residents cannot use residential careservices due to the supply shortage. Increasing their capacity to provide residential careservices and increasing their profitability is congruent with their mission because it willcontribute to residential care services for the community residents.
Top manager F said that after the facilities were damaged by the earthquake andtsunami, they planned new facilities considering both profitability and theirorganizational mission. This nonprofit’s mission is to contribute to community welfare;however, it was difficult to employ new care workers in their town because thepopulation decreased after the tsunami. In addition, services requiring many care
workers are not so profitable. Thus, top manager F decided that the new facilities should
include not only a services floor for elderly people but also a shared residence for young
people that did not require care workers, making it relatively profitable. In addition, top
manager F expected that people looking for work during the post-tsunami
reconstruction would live in this residence and help elderly people. She considered that
this facility would help improve profitability and contribute to their organizational
mission, and thus chose this new investment.
Both top managers E and F considered their reconstruction plan within theirorganizational mission. The organizational mission determines the business domain, andthey did not find a conflict between profitability and the organizational mission.

5.2.3. Lack of changes in management accounting systems
In our interviews, no managers stated that they introduced or changed their
12management accounting systems to improve their organization’s profitability.
Considering this, together with the survey results, we may conclude that management
accounting systems have not penetrated Japanese nonprofit nursing homes as amanagement tool to improve financial conditions. However, many prior studies pointout that management accounting improves financial conditions in nonprofit
organizations, and is popular in hospitals (Carlsson-Wall et al., 2011, Kurunmäki, 2004,
Pizzini, 2006).
We consider three explanations for why Japanese nonprofit nursing homes do notuse management accounting systems. First, managers of nonprofits in the elderly careindustry lack knowledge about management accounting, which is not established as top
management “expertise” (Kurunmäki, 2004). Among Japanese elderly care service
providers, top managers’ backgrounds are mainly as care workers, as evidenced by ourquestionnaire results (average = 14.03 years, median = 12 years, SD = 12.85). In
addition, most had no management education; in our sample, only 23.3% of the top
managers had management education. Japan has national qualifications for certifiedsocial workers, which includes a test for knowledge about managing social welfareorganizations. Many top managers have this national qualification, though the test does
not cover management accounting and includes only financial statement analysis asaccounting-related content.5
Second, top managers may be afraid of resistance from care workers. Previous
studies suggest that tightening management accounting leads to strong resistance frommedical and social welfare professionals (Bracci & Llewellyn, 2012). Some anecdotal
evidence in Japan indicates that care workers do not understand management
accounting information and resist it (Shirinashihama, 2013), implying that any forciblechanges could lead to resistance and potential resignations. Thus, top managers may
avoid introducing or changing their management accounting systems.
Third, there is little pressure to improve management accounting systems inJapanese nonprofit nursing homes (Cardinaels & Soderstrom, 2013). Prior studies showthat nonprofit organizations improved their management accounting systems due to5

However, in the hospital industry, management accounting is recognized as amanagement tool. In Japan, some graduate schools offer a Master of Medical
Administration that provides a course on management accounting. In addition, manyprior studies investigate hospital management accounting.
13

pressure from government funding authorities. For example, Abernethy and Chua
(1996) find that government funding authorities exercised their power to improve
hospital management accounting systems. Carlsson-Wall et al. (2011) also point out thatwhen the deficit of a home help unit dramatically increased, politicians put higher
pressure to improve financial conditions. Thus, the home help unit introduced someadministrative controls, including “increased budget awareness and monthly budget
follow-ups” (p. 321). In Japanese elderly care services, the central government has notpushed for improvements to management accounting systems in nonprofit nursing
homes. If nursing homes were public institutions, then the central government could
exercise such pressure. For example, the central government in Japan forced public
hospitals to improve their financial conditions by making an intermediate plan for
financial improvements (Ministry of Internal Affairs and Communications 2014, 2015).
However, Japanese nonprofit nursing homes are private organizations free from directpressure from the central government.
In summary, the lack of management accounting “expertise” among top managers,
resistance from care workers, and little pressure from the government to improve
management accounting systems contribute to absence of changes in management
accounting systems in nonprofit organizations facing financial difficulties.

6. Conclusion
This study investigates the decision-making process of top managers of nonprofit
nursing homes facing financial difficulties. In general, top managers’ judgments anddecisions have a significant effect on the organization’s performance. We aimed to
expand the knowledge about nonprofit managers’ decision making, use of accounting
information in periods of financial difficulties, and how they dealt with conflicts
between their organizational mission and financial improvement. This study makes acontribution to the literature by applying CDM to accounting research to reveal thedecision-making process of expert top managers in a critical situation. In addition, ourresearch findings can help top managers of nonprofits by providing information about
important aspects of decision making in financial crises.
Our research target was top managers of nonprofit nursing homes in Japan using aquestionnaire survey and interviews. The questionnaire survey revealed that thesemanagers did not introduce or change their management accounting systems whenfacing financial crises to improve their financial performance. In addition, we identified
several ways to improve financial conditions in these nonprofits. We interviewed 714

questionnaire respondents and found that they use accounting information to estimate
the effect of recruitment plans and initiating new profitable business on theirorganizations. They determined restructuring plans based on accounting information,
though time pressure had a larger effect on their decision making.
The top managers we interviewed did not experience mission-profitability
conflicts, and instead avoided implementing profitable plans that conflicted with theirorganizational missions. Respondents did not introduce or change the management
accounting systems in their organizations, possibly due to the lack of management
accounting “expertise” among top managers, resistance from care workers, and little
pressure from the government to improve management accounting systems.
This research is the first step to describing the decision making process of top
managers of nonprofits and their use of accounting information in financial crises. Since
we did not study the results of their decision making, future studies could determine therelationship between the use of accounting information and decision making results. In
addition, research in other environments, such as nonprofit organizations in the U.K. orother European countries, will reveal more interesting and diverse decision-making
processes among top managers of nonprofits in a financial crisis.

Appendix: Summary of interviews
names of organizations

interviewee(s)A

Chief Administrative Officer (CAO; Jimu-cho)

2016/7/18

B

Executive Director, CAO

2016/8/1

C

COO, CAO

2016/8/17

D

COO, CAO

2016/9/15

E

Chief Operating Officer (COO; Shisetsu-cho)

2016/9/16

F

CAO

2016/9/20

G

CAO

2016/9/23

15

Date

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