Accounting and slack – in between efficiency and waste

The problem of slack has been an enduring issue in both the accounting literature and the management literature (Bourgeois, 1981; George, 2005; Wiersma, 2017). It seems difficult to reconcile the understandings that slack is necessary, even integral, for organizational resilience (Linnenluecke, 2017; Vogus and Sutcliffe, 2007), while simultaneously being a mark of inefficiency and wasteful resource use (Merchant and van der Stede, 2023; Nohria and Gulati, 1997). With a pool of resources “in excess” of what is needed to carry out daily operations in normal times, there is always a possibility to cut costs and trim the “fat” off the organization – but there is always a risk doing it “too much,” thereby jeopardizing the organization’s capability to weather difficult times (Linnenluecke, 2017). In the present paper, we take on this question and attend to the dynamics in which slack is created and made usable. We depart from the assertion that slack is always under threat from two sides: either to be subsumed under “normal” and efficient resource use, or to be identified as waste and therefore cut away.

To capture this dynamic, we approach the world as fluid (De Laet and Mol, 2000; Dobusch and Schoeneborn, 2015; Mol and Law, 1994; Yu and Huber, 2023), where stability emanates from the construction of bounded entities such as professional domains and organizations (Abbott, 1995) and where territorializing accounting practices (Miller and Power, 2013) play an important part (Gebreiter, 2022; Kurunmäki, 1999; Power, 2018; Thrane and Hald, 2006). This means that we also adopt a fluid and processual view on resources (Feldman, 2004; Feldman and Quick, 2009; Leuridan and Demil, 2022) and understand slack resources as created in the ongoing dynamics between efficient resource use and wasteful resource use (Miller and O'Leary, 1987).

We show that these dynamics are far from clear-cut. First, the dynamics are multidimensional. Resources “realize context-specific values contingent upon how they are placed in use” (Feldman and Quick, 2009, p. 140). Depending on the purpose or which difference to be made, “the same” resource use can be deemed efficient, wasteful or induced with the potential to become useful (Leuridan and Demil, 2022). If the purpose changes – if there are other differences to be made – the dynamics may shift, and when the resources are used to achieve purposes that are “heterogeneous and plural [in] value” (Bracci et al., 2021, p. 1520), such as in the public sector, a resource use that in one sense appears efficient might in another sense appear wasteful. Second, the dynamics depend on organizational processes (Feldman, 2004), and the accounting practices put in place (Bracci and Tallaki, 2021). When organizational actors strive to extend the purposefulness of resources, making slack part of the “normal” (Gittell et al., 2006; Overmans, 2018; Schulman, 1993), accounting tends to work to delimit and eliminate slack resources, casting them as waste (Nohria and Gulati, 1997; van der Stede, 2000; Wiersma, 2017). We show that it is within these dynamics that slack resources achieve their potential, become usable and multifunctional and where a balance between resilience and wastefulness can be achieved (Linnenluecke, 2017; Mount et al., 2024).

Theoretically, this paper approaches the dynamics between efficient resource use, slack resources and wasteful resource use by using Abbott’s (1995) topological approach to boundary work where boundaries are seen as sites of difference. The theoretical approach is then developed through the engagement with an empirical case, namely, a qualitative study of the multidimensional Swedish elder care and its operations before, during and after the COVID-19 pandemic. Within elder care, there are a variety of differences that should be made along accounting dimensions (making a difference in financial surplus and deficit), social dimensions (making a difference in the meaningfulness and dignity of elderly persons’ lives) and health-care dimensions (making a difference between life and death, sickness and health). When these different dimensions can be recurringly mobilized against and alongside each other, in daily practice, a potential and multifunctionality emerges that can be made useful in times of crisis.

The usefulness of a resource could initially be understood as infinite, but in such infinity, the resource also becomes meaningless and without purpose (Silberstein et al., 2025). Therefore, to achieve any purpose, the resource must be subjected to some sort of structure, channeling or conditioning: it must become limited in its potential and functionality. Feldman and Quick (2009, p. 140) argue “that to become resources, things or qualities have to be put into use, that they then realize context-specific values contingent upon how they are placed in use.” This means that resources can be repurposed when “changes in the internal processes of an organization can take one kind of resource and recreate it as a different resource” (Feldman, 2004, p. 295). While this extends the potential of the resource, it also ties it down to contributing to certain purposes and not others (Mount et al., 2024). Organizational processes thus both enable and restrain the usefulness and multipurposeness of resources.

Accounting tends to further delimit the possible uses of resources. Through the calculative practices of accounting, resources are made scarce (Le Theule et al., 2023), become stripped of their qualities (Robson, 1992) and made one-dimensional (Miller, 2001). Cost accounting has a special role in this (Llewellyn, 1998; Schrøder, 2019). In management accounting textbooks, we learn that cost “reflects a monetary measure of the resources sacrificed or forgone to achieve a specific objective” (Drury, 2008, p. 27). These sacrifices and monetary measures are what the typical enterprise resource planning system would capture when it comes to costs, thereby defining what a resource is and can be in accounting terms. This means that for an accountant, and an accounting system, the conditions of possibility for a resource are that (1) it can be measured in monetary terms; (2) it can be sacrificed or forgone; and (3) it can be connected to a specific objective. Importantly, the third condition does not necessarily have to be met: if a resource can be monetized and measured as forgone, it can be recorded as a cost in the books. It is therefore its ability to be consumed (sacrificed or forgone) and monetized that defines and delimits a “resource” from a cost accounting perspective. Accounting thus constitutes efficiency by connecting resources, in their form as monetized and possible to sacrifice, with the achievement of specific – preferably measurable – objectives (Llewellyn, 1998; Schrøder, 2019).

Waste can be seen as constituted as “other” to efficiency. In this constitution, accounting plays a role through its “capacity to routinely raise questions of waste and efficiency in the employment of resources” (Miller and O'Leary, 1987, p. 240; Wällstedt, 2020). By casting resources as scarce and costly, accounting points out any resource consumption that cannot be connected to organizational output as wasteful resource use (Power, 1997; Wällstedt and Almqvist, 2017a).

In between these two concepts, we find slack: not exactly a mark of efficient resource use, not exactly a mark of wasteful resource use, but resources – in use or dormant – that are in “excess of the minimum necessary to produce a given level of organizational output” (Nohria and Gulati, 1997, p. 604). This “excess” can be manifold: slack resources not only connote tangible “surplus of finance, personnel, supplies or material” (Leuridan and Demil, 2022, p. 1169), but also a surplus in terms of more abstract spaces: spaces in which to act flexibly (Schulman, 1993); spaces in which to think differently (Overmans, 2018); spaces in which to develop new routines (Leuridan and Demil, 2022); and spaces where different types of resources can come together and energize each other (Huber et al., 2021). However, because accounting tends to cast all resource use that do not showcase an “immediate contribution to organizational objectives” (van der Stede, 2000, p. 611) as waste, aiming to eliminate or at least reduce it (Nohria and Gulati, 1997; van der Stede, 2000; Wiersma, 2017), the “excess” resources, that is, slack, tends to be conflated with waste – except for financial buffers created to withstand shocks, which are seen as reasonable slack (Ahrens and Ferry, 2020; Barbera et al., 2017, 2020). Those with resilience in mind, however, seem to argue for the expansion of slack resources: with more potential in terms of usefulness, more situations can be tackled and to build more potential, even more interrelated spaces of resource creation and utilization have to be created (Mangan and Ward, 2024; Overmans, 2018; Schulman, 1993).

There is an interesting dynamic here, we argue. On the one hand, there is an expansive “force” where organizational processes are developed to incorporate more of the potential resources into everyday work (Feldman and Quick, 2009; Leuridan and Demil, 2022): slack resources are made part of the “normal” and become included in what could be seen as efficient resource use. On the other hand, accounting systems cast every use – or sacrifice – of resources that cannot be connected to organizational output – that is, showing an immediate contribution to organizational objectives – as wasteful. Slack is therefore under threat from two sides: one side which aims to make slack resources part of “normal” daily work, thereby removing the taint of “excess” from the potential multifunctional resources that might be undiscovered within the organization, and one side that aims to cut the “waste or fat” (Merchant and van der Stede, 2023, p. 169) from the organization by casting any “excess” resources, that is, slack, as waste. This makes slack a contested space at the mercy of this dynamic. We depict this dynamic, and the contested space of slack, in Figure 1.

Figure 1 shows the outline of a dynamic within which slack is constituted. This dynamic, however, does not play out in a two-dimensional world, but in a multidimensional world of plurality (Bracci et al., 2021). In the present paper, it takes place in Swedish elder care; a multidimensional space of difference, constituted as an economic domain, supported by the technology of accounting and as a specifically professional domain, supported by health-care expertise and intermeshed with social work responsibilities. Within this space of difference, the lives of elderly people become more than something to be saved in an efficient manner: “saving a life” incorporates the meaningfulness of that life – not just the clinical survival of the person (Le Theule et al., 2023). In a social setting, the difference between life and death can thus be drawn up in a multitude of ways, by and for a multitude of actors (Le Theule et al., 2020), making the boundaries of the social fraught with dissension (Wällstedt, 2020).

Therefore, this paper uses a topological approach to boundaries (Abbott, 1995), an approach well-suited for dealing with multiple dimensions. First, this means that we think of boundaries as sites of difference, meaning that we look for differences, how these differences are made and when we find a particular difference that holds a certain consistency in terms of how some things are separated or differentiated from something else, we call that a boundary. Second, like Langley et al. (2019, p. 5), we adopt “a processual constructivist view of boundaries as in flux, as continually becoming,” at the same time as acknowledging the historicity of boundaries; legacies that make them difficult to work upon and change (Lindberg et al., 2017).

With a topological approach, we acknowledge that there is no fully clear distinction between the sites of difference – the boundaries – and the domains or entities they enclose. Rather, boundaries, domains and entities are part of “ongoing topological dynamics that enfolds the spacetime manifold upon itself” (Barad, 2003, p. 826). This means that boundaries achieve a spatial characteristic themselves, as they condition the possibility of spaces of difference – spaces that evolve as different boundaries, that is, different sites of difference, come together in enfoldings (Barad, 2007). In other words, boundaries, domains and entities emerge through ongoing processes that shape space and time. These processes create differences, and when different boundaries meet and fold into each other, new spaces and new possibilities arise. Accounting and calculative practices participate in this, as they conduct topological operations “that create the spatial order within which they operate” (Corvellec et al., 2018, p. 63). The dynamics and the contested space wherein slack are created is, thus, ordered and bounded through a multitude of different conceptions about what constitutes “efficiency” and “waste.”

This goes well with Abbott’s assertions that boundaries are sites of difference, and that “[t]he emergence of an entity is the assemblage of various sites of difference” (Abbott, 1995, p. 872). Any entity or bounded domain can thus be seen as “a combination of properties or dimensions of difference” (Abbott, 1995, p. 862). There is no “core” or “margin” of a domain; instead, there are certain differences that characterize it – whereof some are more important than others. When such important differences are reproduced over and over again, by a distinct group of people and/or particular technologies, a bounded entity or domain appears. An organizational entity, for example, is made up and bounded through – among others – the distinctiveness of legal aspects (is it a limited company, a charity, a provider of public goods, etc.?), its members (are they employees, volunteers, etc.; which competences do they have?), its transactions as recorded in the books (does it perform well in terms of costs, revenues, but also nonfinancial performance measures?), its position in a supply chain (is it a “focal” company, or a marginal supplier?) and the location of its business and premises (is it multinational, national or local?). When these differences come together in an assemblage and are reproduced, the organization achieves its uniqueness. Similar things can be said about other entities or domains – for example, professions and areas of responsibility (Catasús, 2008).

We now turn to the historically constructed domains within Swedish elder care: the accounting domain, the health-care domain and the social work domain. In contemporary Western societies, accounting has, for a long time, participated in creating particular differences, and in doing so, it also contributes to the construction of organizational entities (Kurunmäki, 1999; Wällstedt and Almqvist, 2017a). First, accounting makes a difference in ownership: accounting demarcates what belongs to an organization and what belongs outside (Power, 2018). An employee traversing the boundaries into the organization can be told that “now your time and performance belong to the organization.” This means that the employee’s time is made into a resource that can be measured in monetary terms, and when forgone, the value becomes the organization’s sacrifice. Second, this means that the differences the employee contributes to making become part of the organization’s performance, and become an object of valuation (Millo et al., 2021; Weichselberger et al., 2024). By capturing and valuing the sacrifice of resources and organizational output, accounting demarcates what is costly and profitable (Miller and O'Leary, 1987) and draws a line between what is efficient and what is wasteful. Accounting, thus, participates in both asking and answering questions (Mouritsen and Kreiner, 2016), such as “are you using the organization’s time to perform what the organization finds valuable?” “are you wasting the organization’s time by performing unnecessary things?” and “are we producing the output that we are responsible for?” As such, accounting participates in assembling a rather narrow set of differences, but a set of differences that assume relevance over a wide range of domains (Abbott, 1995; Gebreiter, 2022; Miller, 1998).

The health-care domain is one of the domains where accounting has assumed relevance (Samuels et al., 2005; Sjögren and Fernler, 2019). Health care and medicine emphasize the differences between the sick and the healthy, and life and death (Conrad, 1992; Le Theule et al., 2020). Through practices of diagnosing and the use of normal curves and deviations from those normal curves, medical practitioners determine whether an individual can be seen as healthy or sick, and through practices of treatment, they restore those who are sick to health (Canguilhem, 2015). Establishing these differences, that is, creating boundaries between, for example, sickness and health, is far from straightforward (Conrad, 2005). Nevertheless, these boundaries are often seen as strong and objective (Samuels et al., 2005) and as such, these differences can be emphasized through accounting. When an “objective” diagnosis is established, it is possible to apply standard costing techniques to its treatment (Gebreiter, 2022) to know if a sick person is restored to health in an efficient manner (Le Theule et al., 2023; Samuels et al., 2005). In a historical study, Gebreiter (2022) shows that when the differences that accounting makes are folded together with the differences that health care makes, a new domain emerges: the domain of cost-effective health care. However, when cost-effectiveness is routinely mobilized, that is, when this particular difference is the one that is made to matter, resilience may suffer. Huber et al. (2021), for example, show that a narrow focus on vacating hospital beds during the pandemic was not enough: the beds could not make a difference between life and death without the folding in of other difference-makers – without other equipment and competent health-care workers, the beds were useless.

The domain of social care has also been affected by accounting (Llewellyn, 1998; Schrøder et al., 2022; Wällstedt, 2017). Llewellyn (1998, p. 29) argues that, as a baseline, the “domain of the social services remains unclear and permeated with diffuse and often contradictory purposes.” As such, social work incorporates “sites of ambiguity” leading to questions regarding the “appropriate levels of resourcing” (Llewellyn, 1998, p. 29). Accounting has made inroads within this domain, in the effort to ascertain that resources are used to make “the right” differences (Bukh et al., 2021; Wällstedt, 2017). However, as it seems, with less profound impact than in the health-care domain: the objective of social work – to make a difference in the lives of its various clients – is still comparatively ambiguous and fluid (Schrøder et al., 2022).

It is within this multidimensional space, where boundaries tend to become blurred as different actors contribute to “creating a collective or “relational” space” (Comeau-Vallée and Langley, 2020, p. 1651; Kellogg, 2009), and where conceptions about, for example, ownership, value and efficiency can be loosened and negotiated (Quick and Feldman, 2014), that the dynamics described in Figure 1 take place. Slack, therefore, needs to be understood in its multidimensional character, and in relation to the potential it may acquire when it comes to making many different differences.

The study reported in this article is part of a broader research project focusing on management accounting and control, as well as resilience in the public sector. The background was the COVID-19 pandemic, where Swedish elder care – the responsibility of the local municipalities – was deemed a failure (SOU, 2020:80) with the implication that it needed reformation (SOU, 2022:41). Our overall project aim was to create an understanding of how public sector organizations create resilience in a pluralistic setting such as elder care; a setting where there are different understandings about what is right and wrong, good and bad, and where multiple standards concerning what constitute success and failure exist. However, within this plurality, finances take a center stage: when compared internationally, Swedish municipalities exhibit higher levels of financial resilience than their counterparts in countries such as Italy, Germany and the UK (Steccolini and Lino, 2024).

Through extensive reading of official government reports (e.g. SOU, 2008:51; SOU, 2017:21; SOU, 2018:47; SOU, 2019:43; SOU, 2020:80; SOU, 2021a:52; SOU, 2022:41), historical studies in the field (e.g. Edebalk, 2016, 2020) and our own accounting studies in the public sector and elder care, we have developed a preunderstanding of the elder care field, which serves as the point of departure for this study. Over the past 30 years, elder care has evolved within three distinct domains: social services, health care and accounting. Each domain promotes different understandings of “efficiency” and “good care,” yet they must come together in everyday practice. Social services, grounded in the Social Services Act, emphasize dignity and individual needs. Care is delivered by trained staff using needs assessments, care plans and documentation systems. Health care, based on the Health Care Act, ensures equal access to medical services. Local municipalities, in coordination with regional authorities, employ medically responsible nurses (MRN) to oversee hygiene, medication and palliative care. Accounting, guided by the Municipal Act and the Municipal Accounting Act, focuses on cost-efficiency and budget balance. Controllers and accountants monitor expenditure and support staff in maintaining financial awareness through regular budget reviews. The idea of boundaries was consequently a central premise in this study. Based on this, we made a choice to engage empirically in two municipal organizations where management control systems (MCS) were well implemented in the organizations.

At the beginning of 2023, we approached two Swedish municipal organizations we had worked with previously, here anonymized as BigTown and MidTown. Both had developed intricate MCSs characterized by strict budget control, regular follow-ups and extensive performance measures. Their well-established accounting systems created pronounced boundaries, making them suitable sites for studying resilience.

Anchored in an interpretative qualitative research tradition in accounting (Hoque et al., 2017), we entered the project with certain preunderstandings based on our previous experience of researching the public sector and our familiarity with the two organizations and their MCSs. This gave us a sensitivity to important aspects of the field and facilitated our engagement (Chua and Mahama, 2012). The broader project was guided by a research question concerning how resilience is created in public organizations marked by competing standards of success. To grasp this, we used a theoretical framework on financial and organizational resilience and boundary work, which served as an initial interpretive mechanism to make sense of the empirical material (Chua and Mahama, 2012) and to generate new insights (Alvesson and Kärreman, 2007). Thus, the research problem, our understanding of public sector organizations and the role of management accounting all interacted as we engaged with the field.

We also aimed to refine and challenge our preunderstandings throughout this emergent research process (Alvesson and Sköldberg, 2017). This required an open approach (Peticca-Harris et al., 2016) toward aspects that appeared strange or puzzling (Leigh Star, 2010; Chua and Mahama, 2012). Entering the field with substantial preunderstanding while staying open to “strangeness” presents a methodological challenge (Leigh Star, 2010), and the tension between knowing and not-knowing makes reflexive inquiry both challenging and generative (Haynes, 2017). We addressed this not by ignoring the difficulties but by remaining as open and curious as possible. One strength was that our knowledge of the two municipal organizations differed: one researcher was familiar with one municipality, the other with the other. Likewise, one knew elder care well, while the other had no prior experience. This created a productive tension between familiarity and unfamiliarity, enriching our interpretative work and sustaining curiosity throughout the fieldwork.

As our starting point was the idea that boundaries between different domains shape resilience in elder care, we sought to understand how different groups related to these boundaries and what role management accounting and control played, particularly during the COVID-19 pandemic. To access a range of roles and hierarchical levels, we gained entry to both municipalities at the beginning of 2023 and focused on the purchaser and provider sides. On the provider side, we visited five nursing homes, three in BigTown and two in MidTown. We conducted 50 in-depth interviews with employees in different roles, including senior and middle managers, business controllers, accountants, nurses, assistant nurses and social workers. Interviews, conducted between May 2023 and May 2024, lasted around 1 h (range: 44 min to 1 h and 36 min), were recorded and later transcribed into text documents. See Table 1.

During the interviews, we used a semistructured interview guide, based on central theoretical aspects related to organizational resilience and boundary work. However, in accordance with our qualitative approach, the initial question we asked our informants was open-ended: “Can you tell us about your job and your duties before, during and after the COVID-19 pandemic?” This open-ended question allowed participants to freely elaborate on work-related aspects they considered most significant, enabling the empirical material to emerge from their own worldviews and perspectives. As mentioned before, for us it was crucial to be open to the unexpected, to sense when something might be significant (Kreiner and Mouritsen, 2005). Hence, when we felt that their own storytelling had come to an end, we posed more specific follow-up questions, allowing us to explore particular aspects in greater depth. Through this, we employed the type of interview that Kreiner and Mouritsen (2005) would call “analytic,” where “the interviewer engages the interviewee in the construction of new dilemmas and the exploration of their potential implications for current knowledge about current practice” (p. 154). This is a strategy for “exploring dilemmas,” that is, problematizing actors’ practice in a dialogue with them. The key was to use what Kreiner and Mouritsen (2005) call “double interact,” a question-answer-follow-up sequence, with an emphasis on follow-up questions. In this way, our respondents could expand on their own lines of thought, enabling the conversation to evolve in ways that generated new insights and meanings, developments we could not have anticipated when formulating the initial question. Through this approach, the empirical material became a rich source of field information about the way things were perceived and turned out for each informant, before and during the pandemic.

In designing and conducting interviews with elder care staff, we were attentive to ethical and methodological considerations related to vulnerability and sensitivity, as discussed by Pilbeam et al. (2022). Because our interviews are concerned with understanding how people make sense of their work before, during and after the pandemic, what participants share is an interpretation shaped by both past events and their current situation. In this way, the interview becomes a process of meaning-making. This approach strengthens the study’s ethical foundation by respecting participants’ stories as their own interpretations. We also felt that reflections on the pandemic sometimes acted as “spaces to process experiences” (Pilbeam et al., 2022, p. 5). Many participants were eager to share these stories and expressed pride in their work. At the same time, we recognized the potential sensitivity of revisiting these memories (Pilbeam et al., 2022, p. 4). To address this, interviews were conducted in private rooms at the care facilities, where we could speak without interruptions, using open-ended nonleading questions. We emphasized voluntary participation and allowed time for closure at the end of each session. In line with Pilbeam et al.’s call for ethically active research, our approach aimed to balance the need to capture important insights with respect for participants’ well-being and appreciation of their contributions.

Given the complexity of elder care and its intersecting domains (social services, health care and accounting), an open, interpretative and iterative research design was necessary to capture unexpected insights. Our interpretative process can be seen as a sequence of reflections and interpretations at deeper levels, as well as an interplay between the empirical material and the theoretical perspectives (cf. Alvesson and Kärreman, 2004, 2007). We loosely used a thematic analysis (Braun and Clarke, 2006) to work with the empirical material more thoroughly and closely. This involved taking interpretive notes throughout the process: during interviews and through the rereading of transcripts to capture emerging ideas, comparing these insights across interviews and with each other.

This process allowed us to find repeated patterns of meaning within the data material (Braun and Clarke, 2006). Early in the process, we categorized the empirical material in broad themes related to the enactment of boundaries as “sites of difference,” by looking for differences and how these differences were made in daily work (Abbott, 1995). We, consequently, interpreted our material in terms of the boundaries of accounting, health care and social relations. Later on, in the process of interviewing, a particular analytical hunch emerged (Leigh Star, 2010), namely, a curiosity about the concept of “slack.” We were familiar with the term from both accounting theory and organizational theory, and in the empirical material, it appeared that the accounting perspective dominated: within the organizations, slack was largely viewed as something negative that needed to be eliminated. At the same time, slack in the sense described by organizational theorists seemed to play a crucial role in how the pandemic was managed. When the pandemic hit, slack did exist, after all, and we began to wonder why that was the case. We were consequently puzzled by a seeming paradox: How could slack exist (and prove useful) when the organization aimed to eliminate it?

This led us to explore the concept more deeply from both accounting and organizational perspectives. We found discrepancies between the two literatures, with few attempts to bridge them (Wiersma, 2017, being a rare exception). Our unexpected empirical observation therefore highlighted an intersection that required further investigation, shifting our focus from resilience in general to the role and dynamics of slack during the pandemic. By rereading and interpreting the material more closely, we identified subtle patterns showing how slack emerged at intersections between boundaries, places where different types of differences met and created resources with potential and multifunctionality.

Consequently, our initial analytical pieces, the broad themes of boundaries as sites of differences and their enactments, were gradually integrated with the emerging insights on slack and boundary intersections. The empirical chapter therefore presents a narrative of how boundary work in accounting, health care and social relations intersects and creates spaces where slack is produced. As the rest of the paper shows, this helped us understand how the pandemic could be managed and highlights that the pursuit of waste must be balanced with allowing domains to overlap, so that neither perspective dominates.

Swedish elder care is a social service where the main objective is to allow a life with dignity (SOU, 2008:51), characterized by safety and security, equality and fairness and the possibility to be engaged in society (Social Service Act, SFS 2001:453) ^[1]. It is the professional domain of social workers, and organizationally it is the responsibility of the local municipality. From this perspective, the differences to strive for are social, difficult to measure and evaluate. Therefore, the domain that is enclosed by such boundaries tends to be inherently blurred (Llewellyn, 1998). Elder care should, however, also include health care. Health care is the responsibility of the regional authorities and regulated by the Health Care Act (SFS 2017:30). There is, thus, a strong historically constructed division between elder care on the one hand and health care on the other. The division has two interrelated reasons. The first reason has to do with the medicalized view of the elderly person as sick and frail that dominated at least until the early 1990s in Sweden. By making elder care a social service with explicit social objectives, it was hoped that elderly people would be able to live more dignified, active and healthy lives (Edebalk, 2016, 2020). The second reason is that the medical profession wanted to maintain jurisdiction over health care, which strengthened the boundary between elder care and health care even further. Medical doctors, no one else, should be the ones making a difference between life and death, sickness and health – also for those at an advanced age.

The differences that Swedish elder care should produce are, hence, based on social work and health care, because the creation of these differences is not integrated in a coherent practice or within the same organizational entity, there are strong boundaries that are difficult to overcome. These divisions are exacerbated by the construction of bounded organizational entities. Every local municipality and regional authority is its own economic entity, as stipulated by the Municipal Act (SFS 2017:725) and the Municipal Accounting Act (SFS 2018:597). Three of the most important aspects of this are that every municipality and regional authority levy their own taxes (through income taxation), are required by law to balance their yearly budget, and have been given an increased possibility to build up a financial buffer by producing a financial surplus at the end of the year (SOU, 2021b:75). A local municipality or regional authority is widely regarded as efficient if it can produce a yearly surplus of about 2% of total revenues, while keeping taxes low (Wällstedt and Almqvist, 2017b). Maintaining the differences between surplus and deficit, and high and low taxes, are thus what every municipality and regional authority aims for – something that furthers their boundedness and emphasizes their character as first and foremost economic entities (Kurunmäki, 1999; Power, 2018).

The boundaries of elder care as a social service and the local municipality’s status as efficient are mutually reinforced by a range of nationally standardized performance measures according to which every local municipality can be evaluated and benchmarked (see the Kolada database: Link to KoladaLink to the cited article). The most prominent differences that an elder care organization can make in the lives of elderly people are measured through customer satisfaction measures and measures of experienced safety and security. These measures are complemented by measures regarding the formal competence of care staff. Such measures, focusing on differences that construe the domain of social work, tend to play down the importance of the medical. Over the years, it has become clear that differences of life and death and sickness and health must be included within the organizational entities of the local municipalities. The strict medical responsibility of regional authorities has been loosened by the legal obligation for the municipalities to employ an MRN, challenging the municipal elder care as a pure social service. There have also been ongoing debates regarding where financial responsibilities begin and end, which of the municipalities, regional authorities or central government should pay for what and what type of performance (Socialstyrelsen, 2024).

The two local municipalities we studied focused on making a difference along the dimensions discussed above. To stabilize them as bounded organizational entities, that is, assemblages of various sites of difference (Abbott, 1995), they developed intricate MCSs that would secure the recurring production of the main differences: to maintain efficiency, that is, making a surplus, keeping taxes down and making a positive – preferably measurable – difference in the lives of their citizens. Both municipalities’ MCSs were based on strict budget control, monthly and four-monthly follow-ups and an array of performance measures and other objectives that could be evaluated and used to hold managers accountable.

BigTown implemented their system a long time before the pandemic started. It was quite settled at the time of our study and contributed to the enactment of differences along several dimensions. First, it enacted a difference between purchasers and providers where district committees and their administrations functioned as purchasers of services. The providers could be both in-house and private. Purchasers were funded based on a demographic calculation, according to which the district got its budget based on how many people over 65 years of age lived in that district, and with a small add-on based on socioeconomic variables. There was then a fixed price list according to which the provider was remunerated, that is, a voucher system. The purchasers were faced with a difficult challenge: they needed to break even, despite having little control over demographic changes and therefore over their spending. On the provider’s side, the objective was to keep costs below revenues. Both purchasers and providers, hence, had to make the same difference, that is, keeping a surplus, but the conditions for this differed significantly.

Financial controllers worked to stabilize the production of this particular difference through monthly follow-up meetings with both purchaser managers and in-house provider managers. On the service side, the providers formulated a range of commitments, connected to formalized articulations about which work procedures would be used to achieve those commitments, how resources should be used, how to follow them up and, lastly, a plan on how to develop the work. These commitments were hierarchically connected to a range of operational objectives (often 15–20) and overarching strategic objectives (often 3–5). Commitments and objectives were concretized through performance measures, for example, customer satisfaction, experienced security and safety, satisfaction with meals and activities. These commitments and measures were followed up on every four months. The differences that the municipality was supposed to make were made known through the connection between commitments and performance measures, but they were not followed up on as regularly as the financial figures. This gives us a first clue that the space of differences – the enfoldings where different differences meet – was less stabilized and blurrier when it comes to enacting a life of dignity for their users, than it was for maintaining a surplus. See Figure 2 for a depiction.

MidTown had an overall control system based on a vision, long-term commitments, goals, objectives and strategic developmental areas. The purpose of the control system was to ensure that the political will was reflected in activities, that taxpayers’ money was managed in the best possible way, that the objectives were achieved and that good financial management was ensured. Accounting measures and follow-ups were important but constituted a slightly more traditional budget- and planning-focused model, in comparison to BigTown.

The budget process was designed and managed centrally, but in some respects, actors were involved in giving their opinion in a budget dialogue. During the budget process, there was also a strong collaboration between accountants and unit managers, in which they discussed how to allocate resources to achieve the financial budget. The budget was set by the municipal council: they set the limits for the municipal board and the committees, after which the committees decided remuneration levels for the providers. The previous year’s framework formed the basis for the following year’s allocation, where additions were made, based on forecasted cost increases and deductions were made, based on a general savings model akin to an austerity logic (Barbera et al., 2020). Also in MidTown, the main differences to be made were those pertaining to keeping costs down and maintaining a surplus. This boundary was followed up on often and heavily enforced, whereas those differences that concerned the lives of the elderly were measured through, for example, customer satisfaction and mostly used as input in recurring dialogues. The MCS is depicted in Figure 3.

The nursing homes we studied functioned similarly in both municipalities. They were all demarcated as accounting entities (Kurunmäki, 1999). Some have cost responsibilities, some have both cost and revenue responsibilities and all will have responsibilities for performance. All of them were also located in large singular buildings, divided into sections and staffing was allocated accordingly. Ordinary staff (assistant nurses) usually worked in one section, while nurses and physical therapists moved between them. Residents were all seen to belong to one section. Figure 4 depicts the different entities that have been allocated at least cost responsibilities, that is, are supported and differentiated by the accounting system. It also depicts, in more detail, a standard allocation of staff resources in a nursing home.

There was, thus, a range of entities, that is, assemblages of sites of difference (Abbott, 1995), where accounting stipulated the main and recurring differences that these entities should make. As such, accounting dispersed both budget and performance responsibilities along the lines of these entities. The main accounting entity was the municipality, the entity that is legally obligated to maintain a budget surplus. Both municipalities had made entities of the purchaser function, but in different ways: BigTown made the districts into purchasers, whereas MidTown had a centralized purchaser function. The nursing homes themselves were also accounting entities, in which certain responsibilities were further devolved to the sections. Hence, there was continuous work to make sure that every entity contributed to making a difference both in terms of keeping the budgeted surplus and maintaining a life lived with dignity for their elderly citizens. In other words, it was, to a high degree, the bounded entities on different levels – the assemblages of different sites of difference – that formed the basis for creating the stipulated versions of difference.

The formal lines that have been drawn up through the MCS are objects of struggle and constant negotiations. There are many differences to achieve simultaneously, and they are not easily reconciled. Three key accounting issues, two linked to staff hours, the largest cost driver in nursing homes, and one linked to the role of performance measures, are particularly pressing for managers. The first issue concerns “overstaffing” and the fear that resources, although deployed for “the right” reasons and objectives, may be very costly, that is, a concern that the monetary value of the resources sacrificed is too high. The second issue relates to overlaps between work shifts, raising worries that resources are forgone for the wrong objectives, that is, a concern over resource use being wasteful, with a consequent wish to eliminate them. The third issue concerns the role of performance measures and how they are connected to making the lives of elderly people better. These issues are interspersed with concerns about health care and social care differences, differences that are folded together and assembled in the nursing homes – highlighting the dynamics between efficiency, wastefulness and the potential of resources.

For each nursing home, one strategy for maintaining a surplus and thereby making a significant financial difference was to keep staffing levels low, but not so low that they could no longer make a meaningful difference in the lives of their residents. Therefore, there was a quite clear limit on how many staff should be in place in every section at any time of the day. There was thus a “standard” allocation of permanent staff to each section – a limitation that had been stabilized over many years. The ambition with the standard allocation was to find the exact level of staffing in relation to the level of needs of the residents in each section, reflecting an idea about accuracy, that a certain level of resources could be accurately allocated to a certain level of needs. The standard enacts an efficiency ambition. This accuracy was never achieved, both because resident needs varied and because there were always employees on sick leave, on parental leave or away on competence development courses.

Consequently, a sort of “understaffing” was achieved, which could be balanced by employing casual staff who were called in on short notice, getting paid by the hour. Some managers, however, saw that the permanent staff tended to do a better job of making a difference for the residents. Therefore, these managers recognized the need to employ permanent staff above the line of “normal staffing.” They referred to this as “overstaffing.” In MidTown, one unit manager convinced her superior that overstaffing would actually reduce costs, even though it initially was seen as too expensive and thus identified as waste:

The higher-level manager, who worried that a deficit might arise because the monetary value of sacrificed resources would be too high, nevertheless put these concerns aside and tried out the overstaffing concept. The consequences were positive, with no negative effects on costs and revenues at the end of the year. A new enfolding was thus created, based on the stable reproduction of a specific difference: the achievement of a financial surplus. As a result, the pressure toward eliminating possible waste was temporarily stopped, creating possibilities for assembling different differences within these established bounds, thereby changing the dynamics toward efficiency ambitions.

In BigTown, similar ideas had taken hold before the pandemic, but to feel certain that the crucial difference of a balanced budget could be reproduced, they made thorough calculations beforehand, regarding average sick leave levels to pinpoint the exact level of overstaffing. There were also discussions about unit sizes. One district administration manager said:

This shows that even if the sections within the nursing home are important accounting entities, it is the nursing home as a whole that is supposed to gain a surplus. For this latter manager, it is the district that is supposed to balance its budget – and in the end the whole municipality. This means that a deficit for one lower-level entity can be balanced with a surplus for another, for a higher-level entity to maintain a balanced budget. For each entity – or, following Abbott (1995), each assemblage of different sites of difference – the reproduction of the accounting difference “balanced budget” was a defining boundary. However, this difference could be deflected “upwards” in the organizational hierarchy, making lower-level entities more open and their boundaries blurrier.

As overstaffing unfolded at the nursing homes and some boundaries became blurred, other differences came into consideration and shaped how these spaces developed. Even though overstaffing was considered a financial success, the processes that unfolded created new worries about waste and sparked new efficiency ambitions: resource use might make the “wrong” difference at the same time as it also created potentially usable resources, resources that could make a difference elsewhere or in the future. Overlaps were a central part of this dynamic and will be addressed in the next section.

With overstaffing came the need to make the staff more mobile: if a section was overstaffed, they should be able to cover shifts in other sections that might be understaffed due to, for example, sick leave. This can be seen as a furthering of the blurring of section boundaries, but at the same time the old section boundaries persisted: employees felt insecure in moving across section boundaries, as they had been used to working in “their own” section. The solution was to formalize routines over sections, so they were the same over the whole house, thereby creating similarity and emphasizing the making of certain prioritized differences. At the same time, different types of responsibilities were allocated to select representatives of the staff, such as hygiene routines, organizing social activities, keeping documentation routines alive, developing the meal situation, taking care of new employees or maintaining supply of essential material. The same person could have many responsibilities, and there was more than one person who had the same responsibility. In many cases, these overlapping responsibilities also intersected professional boundaries: nurses had the main responsibility for hygiene, but each section had their own hygiene responsible assistant nurse, and dietitians were engaged in the meal situation at the same time as every section had their own meal responsible assistant nurse. When asking assistant nurses how they found time to take care of their responsibilities, we often got answers like:

Within the overlap between shifts, when five people are in place instead of three, the assistant nurse sees a good opportunity to perform her many responsibilities: a space of potential opens up. However, such overlaps keep unit managers worried about resource allocation issues – are all the staffing hours really making the right difference? Is it efficient or wasteful resource use, or a space of potential?

To make a significant difference financially, each nursing home had to make sure that the staff was used as efficiently as possible, because staff salaries accounted for the majority of their costs. With overstaffing, fixed costs had increased; costs that would now be incurred regardless of whether the time spent was used efficiently or not. Inefficiency related to staffing, in the form of overlaps between morning and evening shifts, consequently held managers occupied on a daily basis. One unit manager expressed his concerns in the following way:

This unit manager did not see a space of potential; he saw “dead time” where resources are in place but not used efficiently. Here, the idea of accurately allocated resources is echoed: ideally, this manager would prefer to allocate resources more precisely, directing them to where they are needed most during the workday and workweek.

From a strict accounting perspective, it is unclear if this type of resource allocation constitutes waste: on the one hand, the nursing home unit does not incur a deficit, but on the other hand, resources are foregone that might not achieve “the right” differences. Moreover, there are instances when there is “lack” of staff resources, which means that some should be moved not just across section boundaries, but also over time boundaries. The worry is that this actually is “costly,” but it is difficult to ascertain whether this is the case – if such overlap constitutes reasonable resource use, slack or even waste (Miller and O'Leary, 1987; Nohria and Gulati, 1997; Wällstedt, 2020).

One main concern voiced by the manager above, that would render the overlaps wasteful, would be that there is inactivity; that the time used is “dead.” As our results show, however, this overlap in time is very much an active time and not passive or “dead time” (Leuridan and Demil, 2022). Instead, there seems to be many efforts to actually realize this space of potential: different important activities and interactions take place between staff, and for the residents and the nursing home as a whole. There was a plethora of different short meetings and assemblies arranged around the different responsibilities, where staff met over professional boundaries and section boundaries. One assistant nurse, who had taken on several responsibilities for taking care of new employees, hygiene, meals and supplies, explained: “It is good to be responsible for meals at the same time as supply, I know what the residents eat, who like bread and stuff like that.” The quote shows that these responsibilities go well together, and with the general responsibility to care for each individual in the way that is best for them. Several other assistant nurses with more than one responsibility reflected that it helped them to carry out daily care in a better way, and that they could be of more help in other sections. And because the routines were similar, they could take on the same responsibilities in different places.

These examples are similar to what Leuridan and Demil (2022) point out as processes that accounting may mark as wasteful and unproductive, because these processes are largely invisible for accounting, but might constitute a slack potential (Mangan and Ward, 2024; Overmans, 2018; Schulman, 1993). With the balanced budget – that is, the difference between surplus and deficit – as the main difference that accounting contributes to making, an ambiguous space of difference opens up. This space is difficult to manage, as the differences assembled here are unclear and not easily visualized (Llewellyn, 1998). There are several concerns over wasteful resource use, but it cannot be qualified by accounting – at least not in its traditional cost accounting form. Therefore, accounting is involved in another way to make sure that “the right” differences are made, namely, through performance measures. But there are also other concerns that need to be taken care of, where accounting seems to be of little help. Some of these concerns circle around making a difference medically; making sure that the residents were on the right side of sickness and health.

The balanced budget requirement provides a clear line of difference that bounds the spaces of difference in which the staff works. This produces a sense of scarcity (Le Theule et al., 2023), putting a limit on how much or many difference(s) can be made. This means that within this space, there are competing differences – some of which become more marginalized than others. One of these was perhaps the most pressing medical issue, namely, keeping up hygiene routines. The MRN was the main responsible person for this, and an interviewed MRN said:

To make a difference between sickness and health, hygiene routines had to be mobilized almost every day. The nurses and assistant nurses with overlapping hygiene responsibilities asked recurring questions about hygiene: they should maintain the line between infection and noninfection every day. This was difficult as making a difference socially was at the forefront, and the limit on staff that was put on each section following the focus on costs. The MRN again:

All these instances are good illustrations of how boundaries intersect, that is, when sites of difference are assembled and come together, for example, in the form of budget limits, use of overstaffing, overlapping responsibilities and staff mobility. When boundaries are allowed to intersect, they create new spaces where differences can coexist – relational spaces of difference (Comeau-Vallée and Langley, 2020; Kellogg, 2009). Again, these spaces are spaces of potential: when different differences are mobilized together and meet each other, possibilities for different resource uses are created. This is, however, hard work: making certain differences, for example, in terms of hygiene, means remobilizing these differences over and over again. Otherwise, both the differences supported by accounting, and the differences pertaining to the social take over: creating such differences is seen as more efficient use of the scarce resources of staff time.

As argued by Llewellyn (1998) and Gebreiter (2022), such ambiguous spaces of difference, as described above, are antithetical to efficiency concerns and the instrumental logic of accounting (Wällstedt, 2020). They are too fluid and need stabilization (Miller and Power, 2013). Therefore, accounting is mobilized for more than cost control – accounting can also contribute to stabilizing differences in terms of the primary output of the nursing home: care quality. To monitor and control costs on an overall level, hierarchically structured reporting systems are complemented with central controllers having recurring dialogues with controllers working with purchasers or provider budgets. The financial budgets are monitored and reported monthly in both municipalities: BigTown reviews performance measures every four months and MidTown in a more ad hoc fashion. This means that the routines for securing a financial surplus are well-established, while there are more concerns about how to think about performance measures and how they are connected to making the lives of elderly people better. A central controller in BigTown argued that the performance measures were of some help:

The importance here was the stabilization of certain levels of performance. Significant negative deviations from appropriate levels of, for example, customer satisfaction, residents’ experience of safety and security, as defined in BigTown’s budget document, would force the nursing home to devise and deploy an action plan. The measures were also used in relation to the four-monthly reports: the central controllers used follow-up discussions with both purchasers and providers. This also worked the other way around as, for example, nursing home managers could contact them. One controller in BigTown said:

These structures, based on measurable performance levels, interventions based on negative deviations from performance levels, and recurring dialogues, provided some stability for managers and visualized some of the differences they were making – especially in social terms. However, dialogue based on questions and answers, initiated, for example, by the “Give a call” model, revealed that many of the indicators and other performance targets were perceived as insufficient at lower levels in the organization, which led central controllers to go beyond their everyday responsibilities and try to help those on lower levels to solve their problems. They acted upon this request and took responsibility and demonstrated the ability to respond above and beyond their formal areas of concern (Catasús, 2008). The relational spaces of difference where many different sites of difference were assembled, required the active contributions of a multitude of actors that could “do more” than stipulated within the bounds of the MCS. Simultaneously, they could not go “too far,” then things would deviate too much. This induced a sense of stability.

In the nursing homes, these indicators were hardly discussed or mentioned. They were present in the unit’s budget documents, and in dialogues between unit managers and controllers, but seldom talked about by employees in the nursing homes, except during “reporting season” every four months. This can be understood in relation to social care’s ambiguous character: it is never clear – at least not for an outsider – which differences should be made (Llewellyn, 1998). Instead, a familiar accounting difference was mobilized on every organizational level: keeping costs down. An administrator at a nursing home talked about how they had devolved responsibilities for purchasing, for example, food and materials to the sections, and how she kept track of these purchases:

Differences from all three domains are assembled in this situation: the ambitions to make a difference socially for residents who have been assessed as more frail than usual, from a health-care perspective, meet with accounting concerns about wasteful resource use. This cross-boundary dialogue introduces an intersection that blurs things: it is initially unclear which difference should take primacy, although the concerns about costs are relayed into the group of care staff, with the probable consequence that they will be acted upon. Again, there is a certain stability provided, along the lines of accounting: it is good and fine with more mattresses for more frail residents – but not too many. Accounting establishes its boundary, but there is a possibility to respond in social and health-care terms. This means that concerns about waste meet with social and health-care concerns about using the resources for the right thing, thereby creating a space for “excess” resources; but an “excess” that must be justified in relation to accusations about wasteful resource use.

While being a strictly bounded accounting entity, where both resource use and performance measures are closely monitored, every nursing home is also supposed to be a social space: this is the explicit demand from the Social Service Act. As such, it should be as open as possible. The residents’ near and dear ones should be able to visit, and, ideally, the residents should be able to come and go as they please. The ideal of a dignified social life leads to openness – a relational space able to incorporate a maximum of different differences. However, the focus on keeping a balanced budget proposes closure; a space delimited to making a difference in line with keeping a surplus. Because the revenues for the nursing home are based on number of residents, there is also a limit on how many staff per resident can be afforded. And even with overstaffing, it is more difficult to take care of mobile and active residents than those who are inactive and stay still in one place.

In MidTown, they nevertheless tried to maintain openness, mobility and activity because that would make a huge difference in the lives of their residents. One of the interviewed managers of a nursing home specialized in somatic care reflected on their openness policy and how that would change if there had been more residents suffering from dementia: “In terms of how the house is designed, it is difficult to lock the sections and have the right security measures in place, which you need if you have residents with dementia.” Here, a distinct line is drawn between the possibilities to care for different “types” of residents. Residents suffering from dementia demand more resources. To keep them safe they must be locked in within their own sections, but also to use staff time as efficiently as possible, because it is a scarce resource. This view was counterbalanced by another manager who actually worked with residents with dementia. In her nursing home, they had sections specializing both in somatic care and dementia care. She discussed their work with a “zero-vision”:

However, the “zero-vision” was counteracted by other forces. The same manager again:

These two managers – the one specialized in somatic care and the one specialized in dementia care – convey that a space wherein staff can make a difference in the lives of elderly people suffering from dementia is an ambiguous one, but also that it is heavily bounded by accounting concerns. Accounting sets limits both on how much staff is available and on how much of their time is available, and it limits what can be done with the physical environment. But when one of the managers welcomes physical limitations (locked doors), the other blames it for “triggering anxiety.” The first manager worries that when things are “too open,” it is difficult to allocate staff resources efficiently. The other manager argues that closed spaces trigger feelings and behaviors that would consume more of the staff’s time. For this latter manager, the openness can be counteracted by broader areas of responsibility and more person-centered care where limitations, for example, putting one’s foot down and giving Charles a shower, even if he says no, are at the hands of the staff. This demands staff that (1) have developed a strong competence in dementia care; (2) have been accustomed to taking responsibility; and (3) have gotten to know the residents through recurring interactions. The conditions for this we have seen above: with overstaffing, the same staff can work more with the same residents and with overlaps in work time, they can take on more responsibilities.

Making a positive difference in the lives of an elderly person can thus be done within the boundaries of a rather tight budget, if many different differences can coexist and meet each other. This means spaces of potential where multifunctionality – the possibility to do and make things differently – is developed (Abbott, 1995; Barad, 2003; Mount et al., 2024). There is little possibility for the accounting system to capture whether this space of difference constitutes waste or slack; the only thing that can be “captured” by accounting is the differences that are made in terms of surplus and deficiencies, and levels of performance measure. Instead, it is up to managers and employees to mobilize other differences that challenge accounting and create spaces of difference within the boundaries made up by accounting (Gebreiter, 2022; Le Theule et al., 2023).

The Swedish government’s strategy during the COVID-19 pandemic contained no close-down of society but did impose a visiting ban on elder care homes (the only real element of “lockdown” in the Swedish strategy) from 1 April 2020 until 1 October 2020. The national strategy has been seen as one of the most liberal ones in the world, leading to harsh criticism. Given the high casualty rate among elderly citizens, especially in the presumed safe spaces of nursing homes, the criticism spawned a debate about a “betrayal” of elderly citizens and a labeling of nursing homes as “death traps.” Some critics argue that the strategy, allowing a widespread of the disease in society, made it impossible to keep it from the most vulnerable elderly and their residences. Without this spread in society, they say, Swedish elder care would have fared no differently from other Western countries. Others have pointed to the lack of health-care competence in municipal elder care, while the Swedish Health and Social Care Inspectorate (IVO) has pointed out that it is the regional authorities that have the main responsibility for health care – and they failed in many respects. It was also concluded that this was far from surprising – the insufficiencies of the Swedish elder care system had been known for a long time (SOU, 2020:80).

There was a widespread fear among those working in elder care – “fear” was probably one of the most-used words by all our respondents. We heard several iterations about how coworkers stayed at home in fear of being infected. The central government, in the form of the Public Health Authority, issued new directives every day, which made things confusing, and despite the mantra that the main objective was to protect the elderly and frail, the municipalities were down-prioritized in comparison to the regional authorities. The situation was unclear at best, and catastrophic at worst, but it became evident that making a difference health-wise was the most significant and important difference to achieve. New boundaries were about to be drawn and a new enfolding – a temporary domain of health care-focused social work – was created.

To make a significant difference health-wise, during the first two months of the pandemic, a set of new lines became clear. First, two new “performance measures” emerged as the most important ones: spread of infection and number of deaths. These two measures were more thoroughly assembled than probably any other measure ever in the history of Swedish elder care. They were first distributed in detail to the Public Health Authority and then disseminated to the public in edited and aggregated forms. Every municipality had to set up its own infrastructure to keep track of them daily. Second, the social character of the nursing home was to become downplayed: what was formerly open was now to become closed – relatives could not come in, and residents could not go out. All in the name of saving them from disease and death. The crisis was framed as a health-care crisis, and the nursing homes were evaluated on those terms. Responsibilities shifted from social to medical, and keeping people apart became the standard where it formerly was to bring them together.

The staff was diminished because many got sick and were afraid of coming to work. And if a staff member had worked with someone who then showed symptoms, that staff member was required to stay with the “cohort” of residents with symptoms. When new differences came to the fore, what could be seen as efficient resource allocation changed. Also, managers were given new duties. Assistant managers became more hands-on, and unit managers had to deal with the new situation: most of the time, they answered calls from worried relatives who could no longer visit their loved ones. The new boundaries were heavily enforced in this way, but others were almost abandoned. As one unit manager said: “All this with following up the finances, and having talks with coworkers, everything like that had to be left aside.”

Top management and politicians in both municipalities signaled rather early on that money was no longer an issue; financial surplus or deficit was not a difference that mattered. All that mattered was to hinder the spread of the virus and keep residents alive. But there was still a worry that overspending would lead to future problems, so when the central government decided to issue emergency grants to the municipalities, it was a great relief. One of the nursing home managers said: “We had to have extra staff, extra resources […] and there was a lot of overtime. But then we got these grants from the central government […]” These grants were complemented with the creation of new expense accounts, so-called “activity accounts,” which were decoupled from the units: overtime and purchases of safety materials debited to the activity accounts did not affect the unit accounts. Consequently, these expenses did not make a difference for the surplus or deficit of the nursing homes.

When boundaries shifted and new responsibilities emerged, a traditional boundary was weakened: the municipalities no longer had to engage fully in balancing costs and revenues; in this case, the central government took over some of the financial responsibilities. This was, however, only a temporary weakening – which was also forecasted by several of those responsible for the municipal finances. One of the controllers we interviewed was somewhat exasperated still a few years after: “As I flagged and said, this can not be the new normal, you can not have as much staff as you want. The staff must understand that this is only temporary. We have to go back, and this has taken a long time.” When costs became “externalized” through allocation to special expense accounts, the difference between surplus and deficit was no longer a part of the assemblage of differences (Abbott, 1995) that made up the organizational entity – and this boundary was difficult to “put back” in place, once weakened.

During the pandemic, the prioritization of making a difference health-wise, over financial and social concerns, created new boundaries. New boundaries demanded that administrative resources were used in a different way, such as the work done by business controllers. The main task of the business controller group in MidTown before the pandemic was to evaluate and control nursing homes in relation to quality. Within the bounds of the formal MCS, this meant follow-up issues and overseeing that nursing homes adhered to rules, regulations and routines. But to maintain systematic cooperation between different functions and roles, they also performed other duties outside their formal responsibilities. In BigTown, cross-functional forums were in place to solve joint problems. This was helped by the controllers who could use the knowledge and the contacts they had created when working outside the boundaries of the formal MCS in normal times.

Early in the pandemic, some controller tasks were abandoned, while other tasks were new. Their knowledge about nursing homes, their communication network, their experiences with cross-functional forums, handling tasks and problems from a cooperative standpoint based on mutual responsibility, could be used for a variety of situations and purposes, in this case, coping with a pandemic. Controllers have now become a hub in an information and communication network. They received information from different instances, distributed this information through their communication channels already in place before the pandemic, answered questions from different providers and became part of the infrastructure, keeping track of the new performance measures and statistics on the spread of disease and deaths. On the one hand, they enacted the stabilization of the new domain, reinforcing that the differences between sickness and health, life and death were what mattered, but on the other hand, they could handle a wide array of differences. Because they had operated within intersections of boundaries for a long time and were used to working with a range of different differences (Abbott, 1995; Barad, 2003), they had developed a potential and multifunctionality that constituted them as slack (Mount et al., 2024).

The strengthened medical boundaries – maintaining the line between health and sickness, life and death – had to compete with the old accounting and social ones, and as always, they could not be held fully stable, because other differences were also mobilized.

When it comes to the old boundaries, accountants kept track of costs and, when applicable, revenues. New costs were incurred en masse, in the form of, for example, protective workwear (visors, and other things) and extra staff. As mentioned, these were not attributed to any entity as usual but to the “activity accounts” discussed above – only to be attributed later, in a way that roughly corresponded to entity consumption. But mostly, the new boundaries had to be managed: disease and death had to be stopped. Preferably in a way that did not interfere too much with work aimed at maintaining a social difference for the elderly residents. Managing the social boundary also became important. For this, the staff were essential. A nursing home manager said:

Although it was possible to find new casual staff, especially as there were harsh restrictions in the hospitality business – many experienced service workers took the opportunity to do their part in elder care instead – it was the “rocks” that made things work. These “rocks” were, however, not just there – they had been nurtured through the different practices in normal times. They had been given responsibilities and were allowed to take them; and these responsibilities had also been allowed to overlap in many ways. Overlaps in task responsibilities were complemented by overlaps in space where staff could work in any section when needed. There was also the active overlap in work time, during which staff interacted with each other and performed their special task responsibilities. Overlaps related to responsibilities were consequently conditioned by overlaps in time and space. All this created relational spaces of difference, where many different sites of difference were assembled. In the enfolding of social concerns, medical issues and resource limitations, staff were developed into multifunctional resources (Mount et al., 2024). This mirrors the results in Leuridan and Demil (2022), where slack is used and produced in daily practices and situational processes although, as described above, it is not always visible for accounting. Given Feldman and Quick’s (2009, p. 140) assertion that “things and qualities must be actively used so their context-specific value can emerge,” we can see that a potential to do just this – achieve new and context-specific values – has been created; a potential that could be used in times of crisis.

In some cases, there were possibilities – for example, in one nursing home where they had a vacated floor ^[2] that could be turned into a “Covid ward” – for these experienced, flexible and responsible coworkers to be turned into health-care workers, taking on some of the medical responsibilities that were normally reserved for nurses. Without their training, flexibility and responsibility, the vacated floor could not have been turned into a “Covid ward.” This corresponds to the case in Huber et al. (2021), where available hospital beds during the COVID-19 pandemic were rendered useless without trained and available staff. The vacated floor, much like empty hospital beds, was in normal circumstances considered waste, but in the new circumstances, and combined with other resources, it became integral for combating Covid.

Moreover, the coworkers described as “rocks” could supervise the new, inexperienced staff. They could also move between sections when necessary and when there was no risk of spreading the virus. In other cases, they could stay in their usual sections, with the residents they had formed relationships with, and try to maintain the open and social care that was their responsibility in normal times. One of the assistant nurses who had worked a long time with the zero-vision, trying to achieve limitless care as well as possible, told us how she worked to uphold both low-restriction care, at the same time as preventing the spread of the disease:

A sort of situation-oriented care was used, this time including more of the health-care issues, in which knowledge of the residents was central. You had to know who was infected or had symptoms, who was more or less mobile this particular time of day, who got anxious about being isolated, who wanted to lie in bed longer in the morning and so on. When you could handle that, you could maximize the openness, while keeping the infected or those with symptoms away from those who seemed healthy.

Health-care differences were assembled with differences associated with social care, and it was through these intersections that new solutions could be applied. The multidimensional work that was done in normal times – for example, the overlaps in time and space and in responsibilities – created relational spaces of difference; spaces of potential. These spaces were always under threat – especially from striving to make resource use more efficient or the accounting-based ambitions to cut waste.

We argue that there are several things to learn from this study about how slack resources achieve their potential, become usable and multifunctional, and in which a balance between resilience and wastefulness can be achieved (Linnenluecke, 2017; Mount et al., 2024). First, we need to look toward the enfoldings (Barad, 2003; Barad, 2007) – the spaces of difference (Abbott, 1995) – that are created, and the role that accounting plays (Corvellec et al., 2018). Within the empirical material, it becomes evident that efficiency – and, therefore, its “other,” waste (Miller and O'Leary, 1987) – becomes ambiguous and unclear (Llewellyn, 1998). It is difficult to determine it, accounting-wise, because the consumption of resources – cost – is measured on a rather high entity level. Moreover, costs are technically unconnected from performance measures: they come together in dialogue, and only occasionally. Together, these uncoupled measures stabilize a rather spacious entity; and by “spacious” we mean a space where a large assembly of different sites of difference can come together (Abbott, 1995). This, in turn, allows for focus on responsibilities, where ambiguous differences can be made together, and where the pressure to account for the accomplishment of narrow accounting-based differences is diminished (Catasús, 2008). Cost accounting clearly shows the limit between surplus and deficit, but it can be relegated “upwards” in the organizational hierarchy, leaving limited but rather open spaces for making different differences in daily work.

Although spacious, the boundaries of this space of difference are continuously upheld, making it far from limitless. In normal times, different differences are mobilized in relation to each other: differences between the frail and the mobile are mobilized in relation to expensive mattresses; differences between the hygienic and the unhygienic are mobilized as a counterpoint to social values and the worries about increasing costs. This can be reiterated and reconfigured in times of crisis. It is also a consequence of the many responsibilities that have been given and taken. When knowing the difference between mobile and frail, knowing what makes a difference between anxiety and not and the importance of keeping residents free from infection, new practices can emerge. These practices grow from the potential that has been nurtured (Leuridan and Demil, 2022). The new, temporary, domain – health care-focused social work – can be realized. This is partially because the difference that is important in normal times – the difference between surplus and deficit – has been temporarily suspended, meaning that the entity widens even more. This, it turns out, has severe effects later on: it becomes difficult to “put the boundary back,” once removed.

We argue that this recurring mobilization of different differences that creates an entity is key to slack management. There is a balance to be found within the dynamic of trying to use resources more efficiently, and the efforts to cut waste. There needs to be some clear boundaries; some stability where some differences are recurringly mobilized (Abbott, 1995; Mouritsen and Kreiner, 2016; Power, 2018). Cost accounting differences could – or even should – be one of those, but to make sure that it does not delimit “too much,” thereby introducing unnecessary scarcity (Le Theule et al., 2023; Schrøder, 2019), costs can be decoupled from the transactional relationship with output (Wällstedt and Almqvist, 2017a) and be made the main responsibility of a broader organizational entity (Kurunmäki, 1999). With the responsibility for efficiency and wasteful use of resources conferred higher up in the organizational hierarchy – but recurringly enforced on the lower levels through ongoing questions and reminders – a space of potential opens up. We would argue that one of the main problems with contemporary health care, where cost calculations are becoming increasingly detailed (Chapman et al., 2022; Chapman et al., 2014; Gebreiter, 2022; Le Theule et al., 2023; Samuels et al., 2005), is that the spaces of difference, through this detailing, are narrowed down. This means that there is no space for slack; there is only resource use that can be transactionally defined as efficient or wasteful (Miller and O'Leary, 1987). In turn, the organizational spaces open for professional responsibility and flexibility become few and far between, and those that are, someone has fought hard for (Le Theule et al., 2023; Leuridan and Demil, 2022; Sjögren and Fernler, 2019).

When it comes to resilience and slack in the accounting literature, we suggest moving beyond a narrow focus on financial resilience. When resilience is seen only in financial terms, slack becomes difficult to address and discuss. Slack is often mentioned in passing or assumed to be closely tied to accounting (see Barbera et al., 2017, 2020; Bracci and Tallaki, 2021), or just hinted at (Ahrens and Ferry, 2020). This, we argue, is a shortcoming that is a legacy of the budgetary slack literature. In the budgetary slack literature, slack can only be cast as waste (van der Stede, 2000; Merchant and van der Stede, 2023). This means that this literature can only reflect upon – never empirically attend to – the potential of slack; this potential becomes an afterthought. Wiersma (2017) commendably points this out, but future studies could adopt an even broader view of slack, like the one advanced by the present paper, to better understand the balance between slack as a potential and multifunctionality, and slack as waste.