Incomplete but Useful? Professional Responses to Cost‐Containment Constructs
研究美国教学医院中不同专业群体如何解读和回应会计成本控制构念的不完整性，发现临床医生、医院管理者和临床管理者因制度逻辑不同而采取反思性改变、务实协商或主动抵抗等不同回应方式。
ABSTRACT Adopting an institutional logics lens, this study examines how different professional groups interpret and respond to incompleteness during the development of an accounting construct in a U.S. teaching hospital. Using an interventionist research design, we co‐developed the construct by integrating financial and clinical data to identify and reduce unwarranted cost variations. Drawing on 28 interviews conducted in winter 2018 and spring 2023, alongside field observations, our findings reveal distinct professional responses. Frontline clinicians recognized the construct's incompleteness but saw value in it as a discussion aid. Guided by a hybrid logic of professional autonomy and patient‐centered care, they adopted a reflexive change response, selectively using the construct to enhance decision‐making. Hospital managers, operating within a segmentation logic of performance and compliance, viewed incompleteness as a manageable limitation. Their pragmatic negotiation response balanced internal support for the construct with external reporting requirements. Clinician‐managers, positioned between clinical and managerial logics, experienced tension when the construct failed to satisfy either. Reflecting a dominance logic where clinical concerns prevailed, they ultimately adopted an active resistance response. We contribute to accounting research by demonstrating how institutional logics shape the performative effects of accounting incompleteness. Although incompleteness is widely recognized as socially constructed and interpretively flexible, our study explains why professionals respond to the same incomplete construct in different ways. We show that institutional logics influence the performative capacity of accounting constructs by shaping how professionals interpret and respond to perceived incompleteness—either enabling uptake, redefining purpose, or undermining legitimacy—depending on how that incompleteness aligns with or challenges dominant logics.