Blame game or dialogue? Financial, professional and democratic accountabilities in a complex health care setting

Purpose - The purpose of this paper is to investigate how the complexity of the network governance setting affects accountability practices. The authors pay particular attention to the organizational characteristics that may enable a common understanding of multiple accountability relationships, or lead to problems in reconciling competing forms of accountability, thereby appearing as blame game-type behavior. Design/methodology/approach - The authors conducted a case study with 31 semi-structured interviews in a Finnish health care organization (FHC) that offers basic public health care services. The organization represents a co-operative arrangement with the main city and three smaller municipalities. The FHC has faced difficulties in balancing budget constraints with the provision of statutory care to citizens. This case is analyzed with the help of theories relating to accountability, the blame game, and dialogue. Findings - The authors found that in the FHC operating under austerity constraints, attempts to reconcile financial, professional, and democratic accountability were made but, instead of dialogue and consensus, the different stakeholder groups resorted to defensive tactics in order to protect their resources, position, or sense of professional obligation. The authors suggest that in a context of network governance, accompanied by an increasing emphasis on financial accountability, organizational practices are susceptible to conflicting accountabilities and behavior characterized in this paper as a blame game. Originality/value - The study contributes to the empirical studies on accountability in the new public governance context by analyzing the complex accountability relations between stakeholder groups with different agendas. The authors suggest organizational characteristics that may exacerbate conflicts between different stakeholder groups and prevent constructive dialogue. Furthermore, the study analyzes the composition of democratic accountability within the studied organization.