Development of costing systems as a process not outcome: a field study of Patient Level Information and Costing Systems (PLICS) in UK health care

Developing accurate cost systems is not only a technical matter of finding and manipulating organisation data from diverse sources, but also an organisational challenge. It requires the participation of non-accountants, to provide access to data they might already hold. Particularly in service contexts, such as health, where the nature of the service can be designed during delivery, their participation is also required to understand the implications of cost data process redesign. This study develops this idea through a field study undertaken in a UK hospital. We find that achieving cost system accuracy can be thought of as a process more usefully than an end-state. We describe a recursive process of making cost systems more accurate which derives from our finding that detecting costing system errors can trigger system improvements. Clinical knowledge is used to allow the costing system to better reflect process and to enhance the efficiency and effectiveness of the processes. Triggering process redesign thus requires further adaptation of the costing system, in turn offering new prompts for consideration, and restarting the cycle of co-production of accuracy in costing.