The complex power dynamics within a health care institution during the 15th and 18th centuries : the case of the Great and New Hospital of Palermo

Introduction: Starting from the Middle Age, the need for discipline and adequate regulation and control has required the most important hospitals to produce special sets of rules, which helped an orderly performance of all administrative and assistance activities of these institutions. In this context, the paper is focused on the "Grande Ospedale e Nuovo" (GON) (today, the Benfratelli Hospital in Palermo), that has been equipped with a set of regulation (Chapters), since its origins in 1431. Aim of the work: The aim of the work is to offer an understanding of how accounting supported the administration of GON within the power dynamic involving civil and religious authorities. Methodological approach: The paper is based on an archival research. A series of primary sources gathered from the historical archive of the GON have been analysed.

In particular, the Chapters issued in 1431, 1442, 1610, 1624 and 1722, which refers to accounting and accountability rules on both financial and nonfinancial information, have been fundamental primary sources for the investigation. To reach the aim of this work, the study of GON Chapters has been complemented with the analysis of a complex of tools, care practices and other aspects of GON life. Main findings: The study permits to show the profound transformation of GON and its administrative changes. It elucidates the role of accounting in the complex power dynamic at work in that context, revealing not only a function of State apparatus of the hospital, but also showing how accounting supported the control exerted by the Pope, the Archbishop and the religious orders involved (Benedictines and Capuchins).

Originality: Exploring the interrelation between accounting and State power in the health care field, the paper has offered a novel contribution related to the Italian context, showing the critical role of accounting practices in supporting the political and social reason of the institution, as connected to public and private support. [Publisher's text].