Extensions and intensions of management control—The inclusion of health

Extensions and intensions of management control:

The inclusion of health*

Mikael Holmgren Caicedo

mikael.holmgren.caicedo@sbs.su.se

Stockholm Business School

Stockholm University

S-‐106 91 Stockholm, Sweden

Maria Mårtensson

maria.martensson@sbs.su.se

Stockholm Business School

Stockholm University

S-‐106 91 Stockholm, Sweden

* This is an Accepted Manuscript of an article published by Elsevier in Critical Perspectives on Accounting on November 2010, available online: http://dx.doi.org/10.1016/j.cpa.2010.07.001.

Extensions and intensions of management control:

The inclusion of health

ABSTRACT

Interest in management control of intangibles has grown remarkably during the last decades and now includes managing employee health. Research in this field is so far in the early stages: few empirical studies have been undertaken and fewer studies take into consideration the implications of such systems. In this paper we wish to contribute to the field with a qualitative study of instances of management control of health in ten Swedish organizations. Many good intentions lie behind the idea of making health and ill-‐health a subject for management control and the expected results are very positive—lower sick-‐leave rates, reduction of costs and human suffering. Such intentions stand for an intension, i.e. the ideas, properties or state of affairs that are connoted by a word or symbol, in this case what can be connoted by the concept of management control of health, its conceptual position. The intension, however, is not given in so far as a word or concept may be associated to more than one. Thus we set out to interpret management control of health in terms two conceptual positions, modernism and postmodernism, in order to bring forth two very different intensions of management control of health: one where the practice is seen as an investment with a purpose to visualize ill-‐health and increase efficiency by putting in place measures to increase employee health; the other where the practice is seen as a means to make the individual accountable in order to be able to intensify control and colonize leisure. Keywords – Management control, health, intangibles, organization of production, production of

organization, modernism, postmodernism

1. Introduction In the last two decades many researchers, practitioners, politicians and policymakers have recurrently stated that a substantial shift has taken place in society. Value creation, they hold, is no longer characterized by tangible investments (machines, properties, etc.). Instead, in what has come to be called knowledge society, investments in intellectual capital such as knowledge, customer and stakeholder relations, image, internal routines, organizational structures, R&D and most presently employee health are argued to be the most important resources (see e.g. Bjurström, 2007; Brooking, 1997; Drucker, 1988; Marr, 2005; Johanson and Mårtensson, 2006; 2007; Johanson et al., 2007; Marr, 2005; Stewart, 1997; Sveiby, 1997). In consequence, management control of intellectual capital has been brought to the fore as organizations search to understand value creation―where it takes place, how it works and what it produces (Blair and Wallman, 2000; Lev, 1999; 2001; OECD, 1999). An ever incrementing number of studies has thus seen the light of day during the last 15 years. Results from OECD funded studies conducted already in the 1980s show that countries investing in intangibles and intellectual capital appeared to increase more rapidly than tangible investments. Other studies, on the level of the firm present a positive relationship between investments in intangibles and rates of

return above capital cost (Lev, 1999; 2001), between disclosure of social information and market reactions (Gray et al., 1995), between HRM quality and market value, between investments in competence development activities and performance, between training investments and profitability (Bassi and van Murren, 1999; Ottersten et al., 1999), and between investments in HR and abnormal return in knowledge intensive firms (Hansson, 1997; Hansson et al., 2004; Hansson et al., 2007). (For an overview see Johanson et al., 2007.) Thus “the term intellectual capital […] continues to gain visibility in managerial literature. In the case of accounting much of the attention has been focused on measuring intellectual capital and reporting it in financial statements” (Fincham et al., 2005, p. 351). This development has also tended to include more and more aspects of intellectual capital, the latest of which, as argued in this article, is the inclusion of health as a subject of management control initiatives and practices (Bjurström, 2007; Johanson and Mårtensson, 2006; Johanson et al., 2007). As recently put forward in this journal, however, “[i]deas and proposals for intellectual capital have largely escaped the scrutiny of critical scholars and researchers” (Fincham et al., 2005, p. 351). Indeed, “to a significant extent […] the practices themselves, as well as the thinking that underpins them” is unquestioned (Mouritsen and Roslender, 2009, p. 803) and “if the intellectual capital concept is as central as some claim it to be, it is vital that it is fully understood and exploited in the quest for social betterment” (Ibid.)

This article is a response to the call for more critical studies on intellectual capital and its consequences. We do this with an empirical study that illustrates one of the latest developments within the field of management control of intellectual capital: the inclusion of health. In effect, the interest in health, its management and measurement, can be understood as bi-product as well as an extension of the attention intangibles aspects such as knowledge and intellectual capital have been awarded as both subjects for management control initiatives that aim at visualizing and measuring through surveys, statistical analysis, bench marking, indicators, contracts between individuals and their managers, ownership of indicators and salary bonuses in order to improve the knowledge and understanding of the value creation process and to increase the ability to compete, grow and survive in the long term (Johanson et al., 2001a; 2001b).

1.1. Management control of employee health Interest in occupational health and safety is not a new phenomenon and dates back to as early as 1700 BC (Åkerlind et al., 2007). Already in the sixties, for instance, Schultz (1961) introduced investments in health as an important facet of investments in human capital and argued that health enhances the qualities of the human resources while Becker (1965) held that morale and productivity was increased with improved employee physical and emotional health. Earlier proponents of such tendencies are described by Mayo (1933) who relates the quest for efficiency with the health of employees as epitomized by the British Health Munition Workers Committee, the Industrial Fatigue Research Board, which in 1930 became the Industrial Health Research Board. In the US similar interests sparked interest to perform the Hawthorne experiments between 1927 and 1932. Even Taylor’s scientific management, although heavily criticized, shows such tendencies insofar as one of its main ideas is that “the task [should] always [be] so regulated that the man who is well suited to his job will thrive while working at this rate during a long term of years and grow happier and more prosperous, instead of being overworked” (Taylor, 1998, p. 17).

The interest in occupational health has become even more acute (Johanson et al., 2007) at the turn of the century in so far as sick leave rates and the cost of ill health increased in Sweden (Marklund et al., 2005), the Netherlands and Norway (Palmer, 2005). This precipitated discussions on how to curb the trend (Marklund et al., 2005; Holmqvist and Maravelias, 2006), which resulted in countermeasures not only aimed at decreasing the length of sick leaves―helping those who are already sick―but also to prevent sick leaves altogether (Johanson et al., 2007). Among other things, in Sweden, several bills were passed that require organizations and municipalities to include sick-leave information on their annual reports (SFS, 2002:1062) and further co-financing of sick leave costs (SFS, 2004:1237; SFS, 2006:1428). The argument in the legislature was to make it more profitable for employers to put measures in motion to decrease the rate and length of sick leaves (Prop., 2004/05:21).

Concomitantly studies have focused on the relationship between ill health and intellectual capital (Ahonen and Hussi, 2007) and found that investments in programs promoting health positively affect performance (Aldana, 2001). Along this lines some organizations have also begun to prioritize health as a key issue, envisioning health not only in the traditional acute sense of occupational health and safety that includes the prevention of work-related accidents and industrial diseases but also in a more holistic sense that includes the promotion of health in general and its connection to individual performance and by extension to organizational performance (Hart and Cooper, 2001). Occupational health measures are thus being put in place in the name of health, which stands as an emblem for quality of life and as an organizational resource for the efficient production of wealth in society (Arneson and Ekberg, 2005). Management control of employee health is in the sense presented above a practice that is underpinned by implicit ideals of rationality reflected by its explicit functioning and functions. In linguistic terms the practice could be denominated as an extension of an intension†, where extension is the set of things or objects in the world to which a word, phrase or symbol applies or extends to, that which is denoted, and intension (see also comprehension) the idea, the properties, qualities or state of affairs that are connoted by the word, phrase or symbol (Kim and Sosa, 1995). In this terminology actual management control practices that revolve around health issues are thus extensions of the phrases “Management control of health” and “”management intellectual capital”, while its intension is the set of qualities or features that are shared by all the extensions to which the phrase applies. In this sense management control of health is seen as a practice that ultimately allows for efficiency through visualization and investment. A description of a turn of events such as the inclusion of health in management control, an instance of management control and therefore its extension, may however be linked to several intensions or meanings in a similar manner as the word “three” can be the extension for the intensions “the number that succeeds the number two” or “the holy trinity” (Kim and Sosa, 1995).

Thus following Cooper and Burrell (1988) we wish to bring forth an alternative interpretation to the oftentimes taken for granted and seldom questioned intension of management control of health, an intension that is founded on modernistic assumptions of rationality, what they call the organization of production. Instead we turn our perspective and view management control of health as the very activity that constitutes and reconstitutes assumptions of rationality. In that sense, in Cooper and

† Not to be confounded with intention.

Burrell’s terms (1988), we turn our perspective to view management control as the production of organization. In doing this we depart from traditional accounting research and follow instead the path opened by Hoskin and Macve (1986), Miller and O’Leary (1987), Hopwood and Miller (1994), Hoskin, (1996), Miller (2001), Power (2004) and others that have turned their attention to view accounting as a social practice that creates the very world in which it functions.

The paper is divided in six sections. In the next section, a theoretical framework is presented in which two conceptual positions, modernism and postmodernism are presented. In the third section the methodology of the study is described. The fourth section is devoted to a description of the extensions of management control into the domain of individual health, i.e. how a number of firms work to reduce the rate of sick-leaves. In the fifth section attention is turned toward two possible intensions derived from the conceptual framework presented in the second section, namely the organization of management control of health and the production of management control of health. We conclude with a discussion and a synthesizing comparison between the two intensions brought forth in the analysis of management control of health.

2. The organization of production and the production of organization

In order to start this critique we turn to organization theory and a series of articles written by Cooper and Burrell (1988) in Organization Studies in which they introduced “the debate in the human sciences between the opposing conceptual positions of ‘modernism’ and ‘postmodernism’” (Cooper and Burrell, 1988, p. 91). The debate, they write, focuses on the nature of information, knowledge and communication and their role in social systems. In modernism, the organization is viewed as an extension of human rationality, a tool with which to change the world according to ideals of progress and reason. Privileging the idea of the organization as a quasi-stable collection of things or properties, modernist notions of organization arise as products of “‘spontaneous sociology’ in which we merely see the reflected images that the organization tends to offer of its own functioning and functions” (Cooper and Burrell, 1988, p. 93). Indeed, classified a priori and implicitly as formal systems of work, the organization’s capacity to ‘produce goods’ thwarts any other conceivable notions. Postmodernism on the other hand, they write, views organization not as the result of planned and rational thought but more as “the defensive reaction to forces intrinsic to the social body which constantly threaten the stability of organized life” (Cooper and Burrell, 1988, p. 91). Postmodernism shifts thus our attention “away from the prevailing definition of organization as a circumscribed administrative-economic function (‘the organization’) to its formative role in the production of systems of rationality” (Cooper and Burrell, 1988, p. 92). It aims at decentering the subject arguing that “the role of the human subject in traditional organizational analysis has been shaped by certain functional requirements: the subject is a ‘decision-maker’ or a ‘worker’, for example; that is, the definition of the subject is dependent on the prior acceptance of a normative-rational model of organization” (Cooper and Burrell, 1988, p. 105). Thus, in the same way as “the organization”, “the subject” is a product of the formation of social systems. Organization is then conceptualized not as the state or manner of being organized but as “a process that occurs in the wider ‘body’ of society

and which is concerned with the construction of objects of theoretical knowledge that are centered on the ‘social body’: health, disease, emotion, alimentation, labour, etc. In other words, to understand organizations it is necessary to analyze them from outside, as it were, and not from what is already organized. It becomes a question of analyzing, let us say, the production of organization rather than the organization of production” (Cooper and Burrell, 1988, p. 106). The lesson to be learned is, accordingly that “organized rationality, far from originating in beau-ideals and consummate logics of efficiency, is founded on sleight-of-hand, vicious agonisms and pudenda origo (‘shameful origins’). This is the revisionary lesson that postmodernism brings to organizational analysis” (Cooper and Burrell, 1988, p. 108).

In this context management control is traditionally a modernist endeavor. It involves management and control according to strategic concerns and the activities involved in inducing employees to act in such ways. It is, in Cooper and Burrell’s terms, a matter of organizing production in order to find the best way to produce a desired result. Such activities include both informal and formal organizational processes of recognizing the elements of the firm’s value creation as well as informing and encouraging employees to act in ways that will promote the creation of value (Johanson et al., 2001a). Promoting health in an organization means then in a way to recognize the importance of health—why it is important to the firm’s value creation process—to communicate it to employees and others—so that they know that it is in their interest as well as the firm’s—and to encourage actions in line with the ideal of health and its value to the organization. In other words, it means to organize the production of healthy employees that will be able to work more effectively as well as reduce sick-leave costs. In this sense management control of health follows a modernist ideal of betterment by way of rational action. It presupposes a thinking subject that has the ability to cognize and represent the object of study (Cooper and Burrell, 1988), i.e. reality out there, the organization or a unit that consists of elements (among others its employees) that can be modeled into a better version of itself according to a plan/vision/strategy that is based on given and taken for granted notions of what is good or bad for the organization, i.e. notions whose veracity is supported by indubitable foundations of rationality, science, common sense, etc. Traditional management control, however, takes for granted the constitutive role of the very activities it seeks to organize. Management control activities can be understood as the production of organization (Cooper and Burrell, 1988). “Organization, in this wider sense, now refers to inclusive and exclusive divisional acts of ‘reality-constituting’ or ‘world-making’ which necessarily precede any form of mainstream organizational theorizing. The latter can only occur after such organizing acts create, stabilize and hence help legitimate objects of analysis such as ‘organizations’” (Chia, 1997, p. 691). In this sense, it can be said that management control not only manages and controls but also creates that which is to be managed and controlled, a governable person (Miller and O’Leary, 1987). In this vein, “[a]ccounting […] is not a passive instrument of technical administration, a neutral means for merely revealing the pregiven aspects of organisational functioning. Instead its origins are seen to reside in the exercising of social power both within and without the organisation. It is seen as being implicated in the forging, indeed the active creation, of a particular regime of economic calculation within the organisation in order to make real and powerful quite particular conceptions of economic and social ends” Hopwood, 1987, p. 213). As Miller and O’Leary (1987), Loft (1991) and Hoskin and Macve (1986; 1994) have shown, accounting can be

reinterpreted as a disciplinary instrument rather than a passive tool of economic efficiency (cf. Arrington and Francis, 1989 and Shotter, 2000). In turn Townley (1993; 1995) has written about how classifications schemes as disciplinary techniques that reduce singularity and establish both the individual’s presence and absence.

Thus, the practice studied here, i.e. management control and its extension into the domain of health, can be said to produce and reproduce a regime that includes values, rules, techniques, routines, and relations of power and makes possible the organization of production.

3. Research method The empirical material presented in this article is based on an empirical study commissioned by the Swedish Occupational Health Agency (Föreningen svensk företagshälsovård) that was conducted in 2007 (Mårtensson and Johanson, 2008). The overall aim of the study was to investigate and analyze the effects and learning of early measures to reduce absence related to sick leave undertaken by firms and occupational health service providers. Suitable organizations were selected in cooperation with the Swedish Occupational Health Agency and some of their member organizations according to whether or not they had both acute health care and preventive health care measures are in place. Interviewees were then selected to meet a blend of representatives with overall responsibility of health related issues in their respective organizations as well as representatives from occupational health service providers. In total ten qualitative semi-structured interviews with representatives from both private and public organizations and representatives from occupational health service providers were conducted either over telephone or in person. Five of the interviewees were HR-managers or HR specialists from four private companies, one from a non-for profit organization and five represented occupational health service providers. All interviews were recorded. The interviews aimed generally at answering the following questions.

1. What kind of measures to reduce sick-leave rates have been conducted? 2. Who are those involved and what are their roles?

3. Why is it important to manage and control employee health? 4. An estimate (qualitative or quantitative) of the outcome that the measures to

reduce sick-leave rates have had. 5. An estimate (qualitative or quantitative) of the probability that the outcome is

in fact related to the measures to reduce sick-leave rates and not to other things.

The results from the study made on behalf of the Swedish Occupational Health Agency were reported elsewhere (Mårtensson and Johanson, 2008) and presented and discussed at an open seminar in October 2007 to which all the interviewees were invited. Prior to the seminar all incumbents had received a copy of an early version of the report where they were asked to comment on the report’s findings.

Taking on an interpretive approach the result from the empirical study are presented and interpreted in the sections that follow in terms of the conceptual pair extension and intension. This pair was chosen for two reasons: first it makes possible the

analysis of words and concepts in terms of two ways of indicating the meaning of a word or concept, i.e. intension and extension, sense and meaning (Frege, 1948), semantics and pragmatics (Carnap, 1942), or meaning and reference (Quine, 1961). Second, the duality in meaning of both extension, it applies both to the act of including yet another feature of intellectual capital as well as the application of a word or concept to denote a practice, and intension, although it is not to be confounded with intention its phonetic similarity makes us think of it as prior to extension, present us with a similar opposition as that we engage in as we conceptualize management control as the organization of production and the production of organization.

Management control of health is thus described by way of three extensions: the inclusion of health in management control practices, the engagement of third parties (i.e. occupational health care organizations) in the management control practice and the expansion of the mission and scope of occupational health care as to include not only acute but also preventive health care. These extensions of management control are in turn interpreted in terms of the theoretical background presented above, i.e. Cooper and Burrell’s (1988) organization of production and production of organization, in order to bring forth their conventional intension as well as an alternative.

4. Extensions of management control of health As has been argued, management control practices can be understood in terms of extensions. In this case it has extended its domain so as to include health as an element to be managed and controlled. Moreover, in order to administrate such extension it has also extended its very organization to include occupational health services that partially have been entrusted with sick leave administration and reporting. Finally the practices have also been extended beyond traditional work place safety and acute health care to encompass issues of life style and general health.

4.1. Including health as an element to be managed One of the main goals of management control is to develop knowledge about the main resources that contribute to the value-creation process In that vein intangibles have been brought to the fore to complement traditional financial values that, as some argue, have lost their relevance in the knowledge era (Johnson and Kaplan, 1987; Kaplan, 1984). Thus the list of intangibles that have been incorporated in management control systems and practices has grown and now includes among others competence, relations to customers, internal structures, R&D and as of late health. According to Nielsen et al. (2007) the inclusion of health as an element of intellectual capital is not far fetched. In effect it can be thought of as the lost foundation of intellectual capital that has now been rediscovered even though evidence, aside from the reports on attempts to produce health statements and to incorporate health in management control practices as described by Almqvist et al., (2007), Bjurström (2007) and Johanson and Cederqvist, (2005), is till scarce (Johanson et al., 2007). Management control of health implies measuring health in order to identify problems and putting measures in place in order to reduce and steer clear of ill-health. The organizations and the occupational health care providers included in this study generate for instance statistics on the number of sick leaves, their length and time distribution in time as well as the reasons behind them. They also work with

employee attitude surveys, health and work environment mappings as well as risk assessments and health profiles in order to be able to customize solutions. The measures put in place to reduce ill-health range in turn from health meetings to subsidized training and therapy as well as measuring and reporting sick leave information. Several companies combine activities such as health profiling, subsidized training and therapy, i.e. a certain amount of money is earmarked so that each employee can purchase preventive health care services and activities at his/her discretion, and health meetings during which consultants such as a company doctor meet with employees to discuss general health and life style issues. Some companies have also benefit packages, which include preventive health care allowances.

4.2. Engaging third parties in management control practices Striving towards lower sick leave rates some organizations have also begun to purchase sick leave consulting services from occupational health service providers. In some examples the services include not only acute health services but also the immediate sick leave administration so that, when sick, employees need only call the occupational health services that in turn will report to the employer. A sick employee, for example, will typically place a call to a determined phone line to be called back by a nurse within a maximum of three hours from the initial call. After the first contact the nurse will keep in touch with the sick employee to mediate contacts with doctors and Social Insurance Agencies—in case the person is absent for caring of his/her sick child. As soon as the person calls in sick the occupational health services informs the company e.g. the closest manager, the personnel manager or personnel assistant as well as the telephone switchboard. The employer receives information that the employee is sick as well as an estimate on the length of the sick leave. At an aggregate level the company will also receive statistics on the number of sick leaves, their length and time distribution in time as well as the reasons behind them. Such a system, the call in service, is however not a new system. Even before the occupational health care provider began to offer the service a similar albeit less developed system had been used by several organizations included in this study. At that time sick leave administration was conducted by the line managers and coordinated by the HR department. But, as line managers often were quite busy, trying to organize and manage operational tasks among the present co-workers they had difficulties to make the system work.

4.3. Turning towards a holistic perspective on health According to the interviewees occupational health has traditionally been a matter of occupational safety as well as acute health care and rehabilitation. Today, however, the organizations and the occupational health care providers studied are aiming to turn their attention towards preventive health care by way of health controls, cholesterol check-ups, anti-smoking campaigns, training allowances, pedometer contests, etc. A preventive perspective on occupational health entails in turn a holistic approach to health that not only encompasses the individual work situation but life as a whole (cf. Åkerlind et al., 2007). Another aspect of the interest in preventive health care is the increased involvement by organizations in training and consultative activities for managers to develop an understanding on how to create a healthy work place. Some of the occupational health service providers have also begun to perform health and work environment mappings as well as risk assessments in order to be able to customize solutions such as, for

instance, individual information on how to work to feel well. Work environment mappings for instance serve as a foundation to provide organizations with training programs on how to work in a healthy manner and in a long-term perspective to help organizations to work systematically with preventive health.

To sum up, we identify three extensions of management control practices. First, there is the extension of management control practices to include health as an aspect to be managed and controlled. Evidence of this first extension is found in the meager but growing body of literature on health issues and management control (Johanson et al., 2007) and accounting but also by organizations, which are beginning to incorporate health in their management control practices. The second extension we relate to is inclusion of third parties in the management control relationship between employer and employee. In effect, to be able to perform a management control function the organizations we studied have extended their reach by commissioning to occupational health services or company doctors and nurses partial fulfillment of acute and preventive health care measures as well as and sick leave administration and reporting. Thus a task necessary for the management control of health is placed outside the organization characterizing the second extension of management control we have identified here. The third extension that we identified is the one that involves the expansion of occupational health to include not only acute health care in the event of accidents but also preventive health care and promotion of health in general. Thus a holistic health perspective is being introduced that encompasses not only the employees work situation but the employee’s whole life situation (cf. Åkerlind et al., 2007).

5. Intensions of management control of health Three extensions have been highlighted: first, the extension of management control practices into the domain of health; second, the extension of the management control system by way of inclusion of third parties, i.e. occupational health services, consultant health professionals, in the management control relationship between employer and employee; and third, the extension of occupational health beyond acute health care, towards preventive health care and promotion of health in general. Having identified these as extensions of the concept “management control of health” we now turn following Cooper and Burrell’s (1988) to two of its possible intensions, i.e. the organization of management control of health and the production of management control of health.

5.1. The organization of management control of health The organization of production is according to Cooper and Burrell (1988) a conceptual position that is centered on a view of the organization as an extension of human rationality and a tool for progress. From this perspective management accounting and control of health is a rational, ahistorical and apolitical practice that is primordially framed from the perspective of the organization (Puxty, 1993). Based on the empirical evidence and within this conceptual position we focus on the intensions of measuring health, putting in place measures for better health as well as reducing and preventing ill-health.

5.1.1. Measuring health: visualization Understood as an element of intellectual capital health is turned into a resource to be managed and controlled. To be managed and controlled it needs in turn to be

subjected to systematized measurement practices. The argument put forward by the interviewees consists of an expressed need to develop knowledge about the employees’ (ill) health and by extension about their contribution to value creation. Through their call in service, for instance, occupational health services can provide general statistics on sick leaves as well as information on their expected time frame, i.e. the expected length of employee sick leave and, in the longer perspective and more generally, how many persons can be expected to become ill, when and why. As some interviewees stated such information enables managers’ decisions in the staff planning process and the day-to day operations both in the short and the long term.

“The statistics we gather can for instance be presented by department, we can divide the numbers into different categories […], we can show whether there are patterns that follow certain week days… we can follow persons individually… whether they alternate sick leaves and leaves for caring for one’s own child and how often they call in sick. And this is a wake-up call to respond quickly” (Customer manager at an occupational health service provider).

In this sense the organizations and the occupation health care providers are implementing diagnostic reporting routines that are based on sick leave information (Almqvist et al., 2007). In so doing they create representations of themselves to identify problems that need to be solved in order to create value. At this stage however such endeavors seems to be driven first and foremost by the occupational health services, whose visions and goals are to develop into consultative services that include not only occupational safety and acute health care but also preventive health care as well as health promotion in general. According to the interviewees from the occupational health services this new role involves helping organizations to set in motion routines for the systematic management of health in order to create a better understanding of the specific situation of the organization in terms of health, e.g. what medical problems are most prominent and among which groups. This simplifies the task at hand and enables greater accuracy, effectiveness and efficiency in the putting in place of occupational health measures to help any employees and to help the organization to become in turn more efficient.

As already stated above, the organizations studied have set afoot diagnostic reporting systems for the management control of health such as health and employee attitude surveys as well as statistics on sick leave, etc. These practices are geared towards the visualization of health as an element of intellectual capital so that it can be managed. Visualization should be understood here as a practice that assumes that the representation of health, the underlying reality, is not problematic per se but only in terms of the techniques of measurement. Reality is thus assumed to underlie any measurement and the only interesting question is whether or not measurements are valid and reliable. In that sense it is also a positivistic practice within which only that which is measurable serves as information. It is also positivistic in its incrementalism and its quest for more information. Indeed, the more knowledge about health the better. Breaking down statistics into different categories, as presented above by a customer manager, provides an instance of the assumption. Indeed, as the same interviewee noted later during the interview.

“The company gets a very good picture over sick leave rates” (Customer manager at an occupational health service provider).

As yet another aspect of intellectual capital the element of health can be understood as a step in the effort to map intellectual capital as a system of variables that have an effect on value creation or, as Nielsen et al. (2007) have pointed out, the lost foundation of intellectual capital, that which ultimately explains value creation. In measuring health visualization is a representational endeavor that seeks to unearth the inner workings of intellectual capital with health as one of the fundamental and enabling variables. More information about employee health is thus expected to enable the organization to produce a better picture of itself from which it can act rationally. In this sense visualization is also functionalistic and ahistorical. It seeks for the explanation that fits best to explain intellectual capital and value creation by concentrating on cross-sectional and aggregate analyses of sick-leave as a proxy to ill-health.

5.1.2. Measures for better health: organizational efficiency Higher costs due to an increasing rate of sick leave and changes in the Swedish governmental sick leave compensation system (SFS, 2002:1062 and SFS, 2002:1065) were thus prime drivers for including health in management control practices.

”Why should we work with this? It is the law…” (Psychologist at an occupational health service provider).

Many interviewees stated that curbing the increasing rate of sick leaves was an important motivator for engaging with occupational health work. Striving towards lower sick leave rates, and hence lower costs, several companies included in the study began to purchase sick leave consulting services from occupational health service providers e.g. the above-mentioned call in service. A personnel manager describes the work with occupational health as follows:

”Naturally, it [the work with occupational health care] is partly a financial question. It costs money to have people on sick leave, to have temporary employees to replace them and pay two salaries. But sick leaves generate also work because managers must administrate the recruitment process of substitutes and train new people. It generates a loss in the organization, managers and co-workers, in terms of extra work” (Personnel manager).

The advantage occupational health service providers tend to hold over primary health care services is that they can take a holistic perspective including physical training, therapy, guidance counseling, and medical help. Thus occupational health work is not only to bring down the rate of sick leaves to a “healthy” and normal level but also to shorten the length of sick leaves by helping the employee back to work as soon as possible. Another advantage held by occupational health services over primary health care is that they can take action much faster.

“The employees think it is very good to be able to talk to a nurse because when you call the primary health care services it takes time… so they do not get to talk to anyone. So we get an overall picture and they get to talk to someone. It is very positive both from the individual and the organizational perspective” (Customer manager at an occupational health service provider).

According to the interviewees measuring health, and specifically making use of the call in service provided by some occupational health services, has also made management decisions such as staff planning easier to take because there is more information about the persons that are on sick leave in terms of expected length as

well as information about the number of employees that are expected to become sick at any given time and why. Such information can in turn be used in the day-to-day operations of the organization to put in place preventive measures both in terms of health and staff.

Although no reduction of the rate of sick leaves has been recorded, managing health has brought about positive results. Outsourcing sick leave administration (e.g. the call in service) to occupational health services has reduced the length of the average sick leave length. Moreover, it has provided the incumbent organizations with a better picture over their respective sick leave rates i.e. how many days an employee is expected to be on sick leave and, in the longer perspective and more generally at an aggregate level, how many persons can be expected to become ill, when and why. Accordingly decisions about staff planning have become easier to take because patterns can be recognized—employees may tend to be sick more often at specific times of the year. In effect, the service provided by the occupational health services includes measurements that describe sick leave patterns. If used those kinds of measurements can turn out to be essential to the day-to-day operations of the organization. Moreover, a better understanding of the specific situation of the organization in terms of health can also be attained, e.g. what medical problems are most prominent and among which groups. This simplifies the task at hand and enables a greater accuracy, effectiveness and efficiency in the putting in place of occupational health measures to help any employees.

”It has resulted in a lower sick leave rate, especially long term sick leave and now short term sick leave too thanks to the occupational health service provider but it’s only been four months. It means that people are coming back to work at a faster pace and that is good for the company. We need our personnel. You cannot throw in anybody and think that they will take on a full load. And our co-workers gain both physically and economically by getting well faster, it is not cheap to be sick. It is a win-win situation” (Rehabilitation manager).

Today, the rates of sick leave have diminished but it is difficult to attribute such decline only to health management control measures since the rate of sick leave has decreased across the board in Sweden. The effect of managing health is in any case often described as a win-win situation by the interviewees. Employees win insofar as they are able to work and not rely on the social insurance office and the organization wins insofar as the rate and the length of sick leave is diminished (e.g. cost reduction) and employees can work more efficiently. Although both the employees and the organizations well-being are promoted as valid reasons for the management of health, the organization’s perspective dominates. This means that a rational and reductionistic perspective, in which only quantifiable terms that can be translated into economic terms, prevails. Moreover, it assumes that social action can be reduced to individual action and that if the individual is controlled so will the organization. Efficiency means thus ultimately organizational efficiency and so the win-win situation portrayed by the interviewees is at the end of the day dependent on the perspective of the organization, in other words, putting measures in place to curb ill-health is understood as an investment.

“We have a company doctor that is here on the premises three hours a week. He is no regular doctor but a consultant. […] I think company doctors with a business perspective are very good! He forwards employees to specialists. […] He trains our managers

sometimes… he solves our problems, he informs and trains us” (Rehabilitation manager).

5.1.3. Reducing and preventing ill-health: investment According to the interviewees managing health has had some positive effects. In the first instance, although no reduction of the rate of sick leaves can be attributed to the management of health, outsourcing sick leave administration (e.g. the call in service) to occupational health services has reduced their length. A representative from an occupational health service provider says:

“We do not get fewer cases of sick leave but people tend to come back to work faster when we help them. The company gets a very good picture over sick leave rates. We can help companies and we can show them that the length of sick leaves has been reduced. The service we provide does cost but if one takes into account the cost of sick leaves the company is making a good investment” (Customer manager at an occupational health service provider).

Working with occupational health services has brought about a change in perspective that can be said to have started by management and their decision to engage and cooperate with occupational health services who in turn have sometimes trained people in the organization to think differently in matters regarding health thus bringing about a proactive perspective. When asked what is left to do a representative of an occupational health care provider said: “to help organizations to work systematically with occupational health care”. Moreover, investing in occupational health is also seen as a way to create loyal employees who appreciate that their employer cares for them and their health.

”I believe in what we do but there are a lot of other factors... if we were to do nothing I am quite sure that it would be worse… one notices it so well on people, one notices that people really appreciate the fact that we are trying to do something and that creates loyal employees” (Rehabilitation manager).

Some of the interviewees gave a sense of an even wider vision that propelled them to work with occupational health related issues. A personnel manager warrants for instance the work with occupational health in the following way:

“[I]t is also about being a good employer. If people feel that we care for them, take care of them and that we try to help in a good way the word will spread outside our company” (Personnel manager).

The exemplified measures are partially dictated by law (a legal argument) but they are also conceived as investments that will yield increased efficiency or cost cutting (a financial and management control argument). Concomitantly, such work has also a humanistic side pertaining to a vision of the good company that takes care of its employees and that understands them in their time of need (a humanistic argument). One of the main ideas behind the management control of health is that there exist a positive relationship between good health and performance and that performance gains are for the best for everyone involved. Although there is no proven causal relationship, at least none that was presented by any of the interviewees, between health management, preventive and acute health measures, and economic performance all interviewees seemed to agree that such work results in lower rates of sick leave and thereby lower costs as well as increased efficiency. Moreover, although

such work can to some extent be characterized as a reaction to governmental impositions it is conceived as an investment on the organization’s part, an investment that in the long run will yield returns in terms of not only lower costs (reducing the length and the rate of sick leaves) and efficiency (reducing losses in performance) but also in terms of image (a promotional argument) both internally and externally. Being a good employer involves taking care of the employees and to have a humanistic interest. These four arguments however, ultimately give way to economic rationality:

”We think that people that feel seen and invested on perform better when they feel good. It is important to care and help when we can. That is our philosophy. The person must be seen and appreciated and we must understand them even when they have a rough time. We gain from it. It is that harsh a reality. It not a charity we run but a business” (Rehabilitation manager).

The investment must thus make sense in rational economic terms and thus it has to be expressed in quantifiable terms, a reduction that can serve as basis for decision-making. Occupational health work is then carried through from a business perspective that is ultimately focused on the organization. In other words, it is a question of resource allocation. Thus the arguments presented in favor of management control of health all can be subsumed to expected return on investment. In effect, the whole idea of working with health as a part of the management control system is based on the idea, the supposition, that there exist a relationship between improved health or, at least, reduced ill-health, and improved performance (cf. Mårtensson, 2007b; 2009).

5.2. The production of management control of health Viewing management control of health as an instance of what Cooper and Burrell (1988) dubbed the production of organization involves a shift of attention from organization as the result of planned and rational thought towards organization as a product that is held in place by mechanisms of power. In this case measuring health, putting measures for better health in place and reducing and preventing ill-health are thus understood as practices to make the individual accountable, to intensify control and to colonize leisure.

5.2.1. Measuring health: making the individual accountable In order to manage and control health a framework needs to be put in place to unearth the underlying state of things and make the individual and his/her health visible. Indeed, as was argued above “[c]lassification schemes are often presented as techniques to analyze labor, reflective of naturally occurring divisions or ordering of ability, skill, aptitude, and so forth. These schemes are, however, very much disciplinary techniques. They proceed operating primarily through enhancing the “calculability” of individuals, as each classificatory or ranking system designates each individual to his or her own space, and in doing so makes it possible to establish his or her presence and absence. Such classification schemes locate the individual in reference to the whole, and in doing so they operate to reduce the individual singularities” (Townley, 1993, p. 529).

From an occupational health perspective the world is divided into health and illness or ill-health through sick-leave as a proxy. The norm is that everybody should be healthy and therefore at work. If not, ill-health should be curbed.

”The faster we can help people and take measures when they come back from sick leave as well as before they fall sick by being able to

identify signals that there’s something wrong in our operations the faster they can come back to work” (Personnel manager).

Defining ill-health as an organizational problem makes it then possible to identify who deviates from the norm. At the most basic level this implies that employees are classified into healthy and ill in order to be able to put health care measures in place. Indeed, in measuring and managing health a programmatic framework is being brought forth from which “the deviations of the person from a norm, with all their possible causes and consequences, become available for investigation and for remedial action” (Miller and O’Leary, 1987, p. 262). This locates the individual in regards to the context of the organization so that the categories ‘healthy’ and ‘ill’ could rather be understood as ‘able to work’ and ‘unable to work’. This classification reduces in turn the individual to categories and brings about a gradation of employees in terms of what is good or bad for the organization. The individual is thus defined by being identified as healthy or ill and in extension as being able to work or not. He or she is thus made accountable in those terms.

Individuals are also made accountable in respect to their role as employees in so far as rights and obligations are built-in in their role as employees. Employees have the right to benefit from preventive measures that may include access to training facilities, therapy, etc. and in acute situations, to doctors, nurses, behavioral scientists, physiologists, and occupational health care professionals and specialists employed by the corporation. Concomitantly, as several interviewees stated the employees’ role in the management of health is to allow the organization to manage them. Access to health measures involves thus an expectation and/or assumption that employees will let themselves be managed in that respect. In effect, the employee is accountable in terms of certain obligations related to his/her health state. S/he is for instance expected to accept the role to be played by the occupational health care provider by granting them access to private records so that their health situation can be assessed as well as live up to the expectation to get well as soon as possible. The individual is also expected, oftentimes implicitly, to grant the occupational health services permission to register individual data in order to aggregate it and forward it to the employer. Moreover, as another interviewee stated, the role of the employee is also to let the employer know he or she needs help. The assumption made by managers is thus that employees ought to participate actively especially in matters of acute health care and rehabilitation. They should also participate in meetings and show initiative by proposing alternatives and suggestions that will help them to get back to work again. The call in service some occupational health services may serve here as an example:

”The effect is that... if the nurse calls you up the first day and you report in sick because you have a cold… the nurse will tell you that you can probably get back to work in two-three days… if the person has not come back to work the nurse will call again on day three which might feel awkward since she [the nurse] said that the person should be back at work then. [they might say to themselves] Why have I not done so? So, then they go to work. They actually do what the nurse tells them to. We can influence them very much.” (Customer manager at an occupational health service provider)

In that sense, the organizational health services come to be and function as a part of the organization: they administrate sick leave, they rehabilitate sick employees and report back to the organizations management. The administrative function implies that

the employee who is sick needs to report to the occupational health services to be accounted for along the categories set in place. Moreover, the employee does not only report her- or himself as being sick but also reports the symptoms from which s/he suffers in order to be told how much time it is acceptable for him or her to be sick. Thus a more detailed framework is created, one that includes different illnesses and an expected time frame for sick-leave. The space that is created for the individual not only includes the categories ’ill’ and ‘not able to work’ but also the time frame after which the individual should come back to work. Accountability is thus transformed into responsibility to comply. In effect, as the quotation above intimates “they actually do what the nurse tells them to” and control is intensified.

5.2.2. Measures for better health: intensifying control The second extension of management control we identified is the inclusion of occupational health service, or in other cases company doctors and nurses, in the organization in order to put in place measures for better health. This is a necessary development insofar as not all organizations trade in health care. This extension however implies changes in the relations between employee and employer. In effect, by way of engaging doctors, nurses and occupational health services the employer and the “manager” of health are associated. Such connection permits a higher degree of private life appropriation by the public life of the company through the management control system (cf. Holmqvist et al., 2006). Indeed, the boundaries of what is normally thought to be all right to share with a doctor or a nurse and with the employer may be very different. Most people would be inclined to tell more about their (ill) health to a doctor than to an employer. Therefore, to protect individual anonymity measures are put in place so that employers cannot identify individual employees. Such measures prevent the occupational health care provider, company doctors or nurses to disclose private information without permission from the employee. The information however travels freely on an aggregate level as the doctor, the nurse or the occupational health service provider are also employed and thereby bound to report data to the company. So, to some extent, as management gains greater understanding about its employees’ health it is also involved in the appropriation of the private and its conversion into public terms by means of measures, statistics, etc. Moreover, management control implies also a control function not only at the aggregate level but also at the individual level. As one of the interviewees stated:

“You cannot question someone that feels ill without being a doctor. It is important, then, to have a partner such as an occupational health service provider that has access to specialists.”

Thus, a health specialist is needed in order to ascertain what and if something is wrong. Such task is above the competencies of regular managers and are thus passed on to the nurses, doctors and representatives from the occupational health services who have the credentials and responsibility to accredit that indeed something is wrong or not and be the first party to authorize measures to be subsequently accepted approved by the employer or on the other hand to deny such measures if there is no relevant medical reason to do so. Thus the management control of health can be said to depend on an apparatus of externalized internal control as the occupational health services manage the sick employees and their sick leave. Insofar as the sick employee deals with the occupational health services rather than with the employer issues of integrity are defended as the occupational health services can be seen as an impartial actor to the employee. Simultaneously the obligating constraining and controlling role

traditionally embodied by the employer is overtaken by occupational health services as they accordingly advise the employee to stay at home for a period of time that is deemed appropriate by the nurse in charge. A controlling routine is thus set in motion as the occupational health services will contact the employee on the third day if they have not returned to work. The occupational health services play then a sanctioning role as well as consultative role as they receive the calls of employees calling in sick and middlemen role between the employer and the employee. As middlemen the occupational health services take on the employee’s duty of calling in sick directly to the employer as well as the sanctioning and controlling role of the employer as personnel manager insofar as they are also the body that registers sick leaves and produces statistics and indicators on sick leave to report to the employer. On the other hand, as an interviewee stated, people who have been in contact with occupational health services in charge of sick leave administration and reporting seem to come back to work on the agreed date. The question is whether the system produces such results because of improved health or because agreements between the employee and the nurse in charge come into play.

In this sense it is important to highlight the relations of power that are at work in such practices. First there is the employer that is the power figure in terms of employment. Such relationship is changed in this context insofar as the immediate sick leave administration is placed in the hands of the occupational health services. The relationship between the employee and the health specialist (an occupational health services employee, a company nurse or a doctor), although different than that of the employee and the employer is however still a hierarchical relationship. In effect, the health specialist has medical science as an ally and can manage the employee and its sick leave thereafter in terms of the legitimacy he or she attributes to the employee’s reason to be sick and also the length that is thought to be appropriate for the reported sick leave. Moreover, the occupational health specialists are employed by the employer of the employee and act thus accordingly on behalf of their customer, i.e. the employee’s employer. The employee in question is then not a client but an employee: a productive resource to the organization that is not productive and therefore needs fixing i.e. help to get well to be able to come back to work. So the management control of health appears to set an indirect relation of power—employee health is not managed directly by managers but through the occupational health services. At the same time, as already hinted, employing an occupational health specialist ads yet another dimension besides the employee/employer relation in terms of power, i.e. a doctor/patient relationship in which the doctor backed up by medical science has power over the patient. As was argued above, measuring health produces categories to define and divide the world. Categories are also tools for accountability and for the identification of deviation that should be remedied. Through occupational health measures and the ambiguous relationship of power that arises, one that fuses together the employer-employee relationship with the health specialist-patient relationship, accountability is in turn transformed into individual responsibility. Thus the individual becomes accountable and responsible to follow direction not only as an employee but also as a patient.

5.2.3. Reducing and preventing ill-health: colonizing leisure The third extension we presented above involves the development from a management control perspective of occupational health beyond work place safety and

acute health care towards a more holistic approach that includes the whole individual. Thus, based on an understanding of health as a sign of quality of life and wealth in society as well as an organizational resource that supports productivity (Arneson and Ekberg, 2005) a holistic health perspective is being introduced that encompasses not only the employees work situation but the employee’s whole life situation (cf. Åkerlind et al., 2007).

Since employee health is conceptualized as undividable (health at work cannot be separated from health at home) a holistic perspective implies that leisure needs to be subsumed into occupational health measuring and measures. In that sense a holistic perspective on occupational health involves the colonization of leisure by work in so far as the categories ‘leisure’ and ‘work’ and their differences are rendered void in regards to health. This means that not only health at work but also health at home needs to be accounted for and managed making the individual’s life style and leisure activities an organizational problem.

Measures such as health controls, cholesterol check-ups, anti-smoking campaigns, and corporate wellness programs serve thus the purpose of accounting and managing the individual’s health. Handing out pedometers to employees in order for them to compete in internal organizational contests is for instance a good example of both measuring health, intensifying control and colonizing leisure. In effect, the pedometer functions as a measuring device that counts the steps of the holder thereby making his or her activity visible and thus accountable. The pedometer is not only worn at work but also on the way from or to work and at home. Occupational health activity is thus not circumscribed to work hours but invades also the individual’s leisure. The pedometer allows thus fitness to be managed by way of counting and accounting the activity of employees. The contests put in place beget responsibility in so far as they turn the private activity of the individual into a public matter, a team effort that is publicly reported and that also allows for peer pressure to take place. The inclusion of health as a subject to management control and the turn towards a holistic approach to health extends thus its boundaries into the realm of individuals’ privacy (cf. Johanson and Mårtensson, 2006; Mårtensson, 2007a; 2007b; 2009). Indeed the employee is no longer employee eight hours a day as stipulated by his/her contract, he or she becomes more and more responsible to live a healthy life not for him- or herself but in order to be able to work for the organization. In effect, as health becomes an organizational problem, the individual and his or her health become a resource so that the reason for keeping healthy tends to become to be able to work. The question that begs then to be asked is, aside employment contracts, for whom the person is supposed to work in the first instance: for him/herself or for someone else? Through accounting categories the world is defined and divided. Including preventive health care as part of a management control system implies then define private life as public and leisure as work. It is yet another aspect of making the individual accountable and the intensification of control by blurring the difference between work and leisure as well as that between public and private life. It is a colonization of that which traditionally has been beyond the employment contract that is fueled by a rationalistic perspective and a technical orientation that never questions the managerial task of management control. In doing so it makes it also impossible to conceive of management control practices in other ways than those it is geared towards.

6. Conclusion As was presented in the previous sections the organization of management control of health involves the extension of management control practices to include health as an intangible to be managed and controlled and the extension of the organization by transferring preventive and acute health care tasks to occupational health services or company doctors and nurses. Moreover, as occupational health work, in the interest of management control, expands from its traditional role that includes occupational safety and acute health care, it also extends the sphere of management control to preventive and promotional health measures. The extensions of management control of health are intertwined with its intensions, a set of ideas that are connoted by the concept that include visualization, efficiency and investment and that are based on a view of organization as a tool of human rationality that is geared towards changing the world in the name of progress. Another intension may however also be interpreted from this practice, one that involves a shift towards the formation of those very systems of rationality we take for granted and how they are formed and upheld. Thus two intensions of management control of health are conceived: one geared towards visualization, organizational efficiency and investment under assumptions of economic rationality and technical orientation and the other focused on making the individual accountable, intensifying control and colonizing more and more of the individual’s life. Extensions of management control

Including health as an intangible: Measuring

health

Engaging third parties: measures for better health

Turning towards a holistic perspective on health: reducing and preventing ill-health:

Intensions of management control

Organizing production

Visualization Organizational efficiency Investment

Producing organization

Making the individual accountable

Intensifying control Colonizing leisure

Table 1: Extensions and intensions of management control of health

In bringing forth the intensions of management control of health we have followed the idea that “[r]ather than seeing, organisational accounts as a technical reflection of the pregiven economic imperatives facing organisational administration, [they can also be seen] to be more actively constructed in order to create a particular economic visibility within the organisation and a powerful means for positively enabling the governance and control of the organisation along economic lines” (Hopwood, 1987, p. 213). The origins of accounting and management control are thus to be understood in terms of the exercising of social power (Hopwood, 1987). In effect, as health has come to be viewed increasingly as a foundation of human capital and thus also of intellectual capital (Nielsen et al., 2007) the role of the organization in matters of health is transformed from an issue responsibility towards its employees to one of responsibility towards it owners. Health care programs must then be expected to yield returns in terms of reduced costs, increased efficiency and contribution to the value creation process. The employee is in turn constructed as a resource to be managed and controlled in matters of health and effectively managed by making him/her accountable but also by transposing power and control from organizational hierarchy to medical science to expand the domain of control and, in other words, colonize leisure.

In order to reach this vision organizations rely upon statistics on the number of sick leaves, their length and time distribution in time as well as the reasons behind them, employee attitude surveys, health and work environment mappings, risk assessments, health profiles, health meetings, subsidized training and therapy, preventive health care allowances, organizational doctors, nurses or occupational health services, etc. Such methods create standardization by way of taxonomies that establish “an ordered succession between things, stating how relations between beings or things are to be conceived” (Townley, 1995, p. 560). In effect, by recording, classifying and measuring, these methods convert individuals and their health into comparable units expressed by common denominators thereby providing the basis for management/government through disciplinary power. Moreover, these methods also allow for remote control, displacement and abbreviation (Zuboff, 1988). As Robert Cooper writes, an economy of remote control “is made possible by substituting symbols and other prosthetic devices for direct involvement of the human body and its senses. Administrators and managers, for example, do not work directly on the environment but on models, maps, numbers and formulae which represent that environment; in this way they can control complex and heterogeneous activities at a distance and in the relative convenience of a centralized work station” (Cooper, 1992, p. 257). Thus, by way of accounting numbers and taxonomies employee health is converted into common denominators that enable comparison. Such translation implies the possibility for management to control and literally manage the inscribed products of categorization and measurement as they can be manipulated, combined, rewritten, communicated, moved, copied, etc. In that sense it can be said that employees and their health are visualized or rather translated into something visible to the managerial eye. Such standardization implies also a reduction in that some aspects are focused upon while others are neglected. Indeed, as employees and their health are made visible it is clear that the vision created is not reality but a reflection of it, a representation and as such “by its very nature as a terminology it must be a selection of reality; and to this extent it must function as a deflection of reality” (Burke, 1966, p. 45 [italics in original]). Accordingly, to give an example, the representation of the employee that results from a holistic perspective on health deviates so as to blur the line between private and public. This blurring together, a result of the inclusion of health as an element of intellectual capital, transforms thus the private realm into an organizational one. The representation of the employee, however, “is always of something or someone, by something or someone, to someone” (Mitchell, 1995, p. 12) and is the result of the production of knowledge functions around inscription devices whose products represent in writing the work of measuring (Latour and Woolgar, 1979). Indeed, the problem they highlight is that the translation process between measuring and measurement tends to be erased from memory giving way to a direct relationship, one that seems unaltered, between the substance and the written product produced through inscription devices. In trying to figure out the meaning of the inscribed end-product the whole process is forgotten, taken for granted, and deemed of marginal importance. Thus, through a process of splitting and inversion, measurements are split from measuring and inversed so that they become the point of departure rather than the result. In this manner measurements as they are incorporated into managerial action become facts that are attributed the status of objective independence rather than the status of being a social construction. As the authority of judgment is transposed from

the organization to a health organization backed up by medicine the illusion of facticity of employee health measurements is intensified to an even higher degree. Again, however, the question that is effaced through this process is that of genesis: for whom and why is a certain measure of employees’ health produced?

In writing this article we have tried to show how an organizing practice, management control of health in this case, and its assumptions are not necessarily given but products of the exercise of social power. In effect, including health as an intangible to be measured and managed, engaging third parties to put in place measures for better health and turning towards a holistic perspective on health need not necessarily be extensions of ideals of visualization, organizational efficiency and investment (intensions that are framed by the perspective of the organization) but can also be understood as intensions of a social power play that aims at making the individual accountable, controllable and colonizable in order to create an even more governable person. In this sense we contribute to the strand of accounting literature by the likes of Hoskin and Macve (1986), Hopwood (1987), Miller and O’Leary (1987) and Townley (1993). We do this by bringing forth an alternative intension to the intentional and rational management of health. Through the inclusion of yet another aspect of intellectual capital we also point to the intensification of the governability of the person expressed by the inclusion of leisure time as a subject for organizational calculative practices. The inclusion of the behavioral into accounting practices, as expressed by Miller and O’Leary (1987), is thus no longer limited to the behavior of the employee at the workplace but to the individual whenever and wherever he or she might be.

Acknowledgements The authors are very grateful to the many valuable comments from the two autonomous reviewers.

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