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This paper presents a systematic literature review aiming at analysing how research has addressed performance measurement systems’ (PMSs) ambiguities in the public sector. This paper embraces the ambiguity perspective that PMSs in public sector coexist with and cope with existing ambiguities.

The authors conducted a literature review in Scopus and ScienceDirect, considering articles published since 1985, and the authors selected articles published in the journals included in the Association of Business Schools' Academic Journal Guide (Chartered ABS, 2018). Of the 1,278 abstracts that matched the study’s search criteria, the authors selected 131 articles for full reading and 37 articles for the final discussion.

The study's key findings concern the elements of ambiguity in PMSs discussed in the literature. The study’s results suggest that ambiguity is still a relevant problem in performance measurement, as a problem that is impossible to be solved and therefore needs to be better understood by researchers and public managers. The analysis allows us to summarize the antecedents and consequences of ambiguity in the public sector.

The key findings of the study concern the main sources of ambiguity in PMSs discussed in the literature, their antecedents and their consequences. The study results suggest that ambiguity exists in performance measurement and that is an issue to be handled with various strategies that can be implemented by managers and employees.

Managers and researchers may benefit from this research as it may represent a guideline to understand ambiguities in their organizations or in field research. Researchers may also benefit from a summary list of the key issues that have been analysed in the empirical cases provided by this research.

This research may provide insights to limit ambiguity and thus contribute to improve performance measurement in the public sector.

This research presents a comprehensive review on the topic. It provides insight that suggests what future research should attend to in helping to interpret ambiguity, considering also what should be done to influence ambiguity.

The purpose of this paper is to discuss the potentialities of innovative accounting tools in supporting “transparency” and “resource allocation” in public hospitals, by describing the implementation of a pilot project of time-driven activity-based costing (TDABC).

An interventionist research (IR) approach has been adopted: two medical doctors, three financial controllers and three researchers were involved. Collection of data used to implement the accounting model is based on hospital databases and interviews.

The information produced may allow a higher coherence between resources and activities. TDABC may enhance transparency and support decisions toward a better organization of work and an informed allocation of resources.

Further studies are required to analyze decisions following the implementation of the TDABC model.

The accounting literature lacks case studies describing the application of TDABC in hospital settings, despite its good informative potentialities and the limited investment required to introduce TDABC. Moreover, the use of the IR approach and the involvement of medical doctors may help to get coherence between accounting data and clinical work and may support the further diffusion and development of this costing model in hospitals.

The purpose of this paper is to analyze the potentiality in the application of process analysis and activity‐based costing (ABC) in a healthcare setting to produce usable, useful and correct information on resource consumption and processes. The paper aims to analyze changes applied to the traditional costing model in order to represent the work flow of the organization and the related additional information usable by decision makers at different levels. In particular, the paper is focused on economic analysis related to the introduction of a new surgical technique in healthcare.

An empirical case study is developed in a Tuscan hospital from September 2005 to March 2006, data being collected through interviews to employees and direct observations.

Several factors are found to be critical in such a process analysis and in an ABC implementation in healthcare. First, the need to ground the development of the model structure on the specific characteristics of the organizational setting and the clinical work performed. Second, a problem of culture and language, because professionals have difficulties in understanding the language of activities, and they cannot accept a model designed to measure their work; therefore, some resistances may occur. Third, the constraint of information; in fact more precise estimation may be limited by the information available, as in this case.

The paper provides a framework for future research. The replication of the methodology in other hospitals, in order to test the validity of the model and to compare results, can be interesting and another can be the analysis of benefits that the application of the system can provide (in terms of improved efficiency) through a longitudinal analysis.

The paper contributes to the field study of ABC and process analysis in healthcare. The original contribution of the model lies in the classification of activities in a hierarchy across the organization, which allows a more precise identification of cost driver; and in the “hybrid” nature (a combination of cost centres and activities) of the model. The latter allows one to identify a “full cost” of the patient.

The purpose of this paper is to set out a methodological framework to investigate how the integration of an activity-based costing (ABC) logic into the pre-existent accounting system supports healthcare organizations in identifying the inefficiencies related to their diagnostic therapeutic pathways (DTP) and related reengineering interventions.

The BPM-ABC methodological framework has been applied to the case of a specific surgery pathway, at the Orthopaedic Division of a University Hospital in Italy.

The case-study described in the paper points out: first, how the Business Process Management (BPM)-ABC methodology is able to produce significant information about consumed resources and the costs of the activities, useful to highlight opportunities for DTPs improvement; second, the barriers related to a pre-existing accounting system based on cost centres that can hinder the implementation of the BPM-ABC model.

The case study points out the role of the ABC as a management tool for supporting decision-making processes. The ABC allows inferring information for two purposes. First, ABC supports a cost containment process as it allows highlighting the most cost-consuming activities and resources. Second, the ABC allows identifying reengineering paths, distinguishing between incremental and radical ones.

This study represents a remarkable reference raising the awareness of the pivotal role accounting systems play in the management of the organizational processes.