Healthcare organizations are different in time and space. Based on the nature of the State’s choice to guarantee health protection to the citizens, it is possible to observe different kind of healthcare organizations, whose management process is driven by different criteria. Likewise, differences would be observed when a longitudinal analysis is conducted. Mark (2006: 851) argues “the scope of healthcare provision ranges from traditional healers in the developing world to medical consultants practising in the most sophisticated western hospitals. What they have in common is participation in an activity that requires trust between the parties concerned, to deliver a change in the patients’ well-being”. Historically what shaped the organisation of provision was different (Porter, 2003); so, for example, the purpose of hospitals historically changed from segregation to clinical intervention, especially once anaesthetics and antisepsis arrived to change the practice of medicine and outcomes for patients. However, observing healthcare organizations located in different country contexts today, allows at highlighting that somehow “the past still exists”. Therefore, what matters in healthcare team working today in the Western countries is different from what matters, at the same time, in strife-ridden countries, where a lack of any sense of the future and an aversion to risk changes behaviour (Mark, 2006: p. 852). During late 80’s and early ‘90s, many Western countries changed the relationship between states provision and the private sector, the latter being used as a new template for designing public organisations, including those in healthcare (Hood, 1991). The approach, originally named New Public Management (Ferlie, 1999), brought changes to the context of health delivery in several countries (Barzelay, 2002). Similar reforms were implemented in diametrically opposed country’ system, aiming at increasing efficiency, and at introducing managed care and managed competition criteria (Toth, 2010). The reforms introduced the role of the clinical director and new accounting technologies to both measure results, and monitor the healthcare organizations’ ability to challenge efficiency objectives (Llewellyn, 2001). Sheaff et al. (2003) pointed out that measurement was focusing only on what goes in and what comes out without looking at the process inside, so the healthcare organization appeared to be as a black box. Health services’ delivery is the result of a complex process; a number of knowledge exchanges occurs among the actors of the process; and many individuals participate sharing values, routines, protocols, etc. Any person perceives the crucial role of the healthcare organizations for his/her wellbeing, and the quality of the healthcare experience is mainly linked to the process dimension. The accounting literature has often depicted the healthcare organizations from a financial perspective, highlighting the role of the accounting technologies for management control. Thus, both the healthcare organization as a whole and its sub-units have been examined (Vagnoni and Oppi, 2015). This approach has rooted the new concepts and knowledge among the clinical directors, whose performance has been often assessed based on their ability to contain costs and respect the budgets’ cap. Furthermore, financial issues have sometimes become the main drivers of healthcare organizations’ strategic management. Nevertheless, many countries have recognized that the future of universal coverage health care systems depends on their ability to keep abreast of changing needs and respond to these in an appropriate way in order to sustain public confidence. The ability of the healthcare organization to cope with patterns such as innovation, knowledge management, communication, treatments’ decision, appear to be crucial (Coulter and Jenkinson, 2005). Thus, intellectual capital is a comprehensive framework for valuing those patterns. One of the main peculiarity of healthcare organizations lie on developing value creation processes through a combination of both tangible and intangible assets. The latter plays a dominant role in a knowledge-driven organization such as the healthcare one; as a consequence managing intellectual capital determinants would leverage the organizations’ ability to create value and be responsive to health needs. Beyond an increase of the studies related to the use of intellectual capital for organizations’ management, the healthcare organizations still appear to be as black boxes: costs and financial results are well known, but how intellectual capital interacts to pass knowledge, to create innovation and value, is not known, nor monitored. In spite of the centrality of the efforts to mobilize knowledge and innovation to legitimize the healthcare organizations’ strategic role in the society, accounting literature has surprisingly devoted limited attention to capture their drivers, the intellectual capital dimensions. Therefore, the chapter aims at discussing the importance of IC framework for healthcare organizations’ management purposes. To that end, section 2 describes the characteristics of the healthcare organizations’ context; section 3 focus on the role of knowledge in professional based organization such as the healthcare ones; section 4 analyses the contribution of the IC accounting framework for managing the healthcare organizations; section 5 includes an analysis of the accounting literature on IC in the studied context; and finally section 6 presents some concluding remarks.

### Intellectual Capital in the Healthcare organizations' context: does it matter?

#### Abstract

Healthcare organizations are different in time and space. Based on the nature of the State’s choice to guarantee health protection to the citizens, it is possible to observe different kind of healthcare organizations, whose management process is driven by different criteria. Likewise, differences would be observed when a longitudinal analysis is conducted. Mark (2006: 851) argues “the scope of healthcare provision ranges from traditional healers in the developing world to medical consultants practising in the most sophisticated western hospitals. What they have in common is participation in an activity that requires trust between the parties concerned, to deliver a change in the patients’ well-being”. Historically what shaped the organisation of provision was different (Porter, 2003); so, for example, the purpose of hospitals historically changed from segregation to clinical intervention, especially once anaesthetics and antisepsis arrived to change the practice of medicine and outcomes for patients. However, observing healthcare organizations located in different country contexts today, allows at highlighting that somehow “the past still exists”. Therefore, what matters in healthcare team working today in the Western countries is different from what matters, at the same time, in strife-ridden countries, where a lack of any sense of the future and an aversion to risk changes behaviour (Mark, 2006: p. 852). During late 80’s and early ‘90s, many Western countries changed the relationship between states provision and the private sector, the latter being used as a new template for designing public organisations, including those in healthcare (Hood, 1991). The approach, originally named New Public Management (Ferlie, 1999), brought changes to the context of health delivery in several countries (Barzelay, 2002). Similar reforms were implemented in diametrically opposed country’ system, aiming at increasing efficiency, and at introducing managed care and managed competition criteria (Toth, 2010). The reforms introduced the role of the clinical director and new accounting technologies to both measure results, and monitor the healthcare organizations’ ability to challenge efficiency objectives (Llewellyn, 2001). Sheaff et al. (2003) pointed out that measurement was focusing only on what goes in and what comes out without looking at the process inside, so the healthcare organization appeared to be as a black box. Health services’ delivery is the result of a complex process; a number of knowledge exchanges occurs among the actors of the process; and many individuals participate sharing values, routines, protocols, etc. Any person perceives the crucial role of the healthcare organizations for his/her wellbeing, and the quality of the healthcare experience is mainly linked to the process dimension. The accounting literature has often depicted the healthcare organizations from a financial perspective, highlighting the role of the accounting technologies for management control. Thus, both the healthcare organization as a whole and its sub-units have been examined (Vagnoni and Oppi, 2015). This approach has rooted the new concepts and knowledge among the clinical directors, whose performance has been often assessed based on their ability to contain costs and respect the budgets’ cap. Furthermore, financial issues have sometimes become the main drivers of healthcare organizations’ strategic management. Nevertheless, many countries have recognized that the future of universal coverage health care systems depends on their ability to keep abreast of changing needs and respond to these in an appropriate way in order to sustain public confidence. The ability of the healthcare organization to cope with patterns such as innovation, knowledge management, communication, treatments’ decision, appear to be crucial (Coulter and Jenkinson, 2005). Thus, intellectual capital is a comprehensive framework for valuing those patterns. One of the main peculiarity of healthcare organizations lie on developing value creation processes through a combination of both tangible and intangible assets. The latter plays a dominant role in a knowledge-driven organization such as the healthcare one; as a consequence managing intellectual capital determinants would leverage the organizations’ ability to create value and be responsive to health needs. Beyond an increase of the studies related to the use of intellectual capital for organizations’ management, the healthcare organizations still appear to be as black boxes: costs and financial results are well known, but how intellectual capital interacts to pass knowledge, to create innovation and value, is not known, nor monitored. In spite of the centrality of the efforts to mobilize knowledge and innovation to legitimize the healthcare organizations’ strategic role in the society, accounting literature has surprisingly devoted limited attention to capture their drivers, the intellectual capital dimensions. Therefore, the chapter aims at discussing the importance of IC framework for healthcare organizations’ management purposes. To that end, section 2 describes the characteristics of the healthcare organizations’ context; section 3 focus on the role of knowledge in professional based organization such as the healthcare ones; section 4 analyses the contribution of the IC accounting framework for managing the healthcare organizations; section 5 includes an analysis of the accounting literature on IC in the studied context; and finally section 6 presents some concluding remarks.