Engaging Michel Serres 'theory of relations' this paper provides the means to theoretically explore the connections between high-level accounting conceptualisations and the multiplicity of expertise and low-level practices. A typology has been developed from stories of clinical governance and practices directed at linking 'good care' with rational marketplace concerns of efficiency and efficacy. In this study, a relational form of accounting emerges, offering a practical, and political, means for accounting intervention.