Objective of the research (What?) This research analyzes how a new cost accounting system - patient-level information and costing system (PLICS)- is embedded in NHS trusts. It aims to produce (a) a handbook for best practice of PLICS implementation and use for NHS trusts and to provide (b) critical analysis of system-wide factors interfering in this process. Background (Why?) The Department of Health (DH) is currently introducing a new cost accounting method in NHS trusts: PLICS. This new method has the objective not only improve the quality of cost data, but to improve significantly the quality of health care. Shifting the question from where costs are produced to wherefore they are produced, the focus is on the efficiency and quality of actual health care processes rather than on units or departments. However first experiences show that some trusts failed to complete the implementation process and others having implemented PLICS struggle to transform it in an effective management tool. If individual behaviors may be at the origin of some of these failures, other failures may be linked to system-wide factors: The traditional vertical management structure of the NHS may be resistant to attempts to introduce elements allowing a horizontal perspective. The NHS would benefit from conceptual guidance on and access to critical variables of the initial PLICS implementation, subsequent PLICS-use and their link with wider systemic factors. But currently there is little conceptual guidance systematizing these critical aspects. Methods (How?) In order to analyze PLICS implementation, use and system-wide factors we propose to combine literature review, quantitative analysis and case study method. Data collection is based on questionnaires, analysis of documents, semi-structured interviews and observation of meetings across NHS trusts having implemented PLICS.
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