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The purpose of this paper is to explore two hospital departments, one of which is laterally dependent on the other to function, but which are subject to distinct vertical managerial controls. This complexity in vertical–lateral relations generates tension amongst the hospital’s senior managers and a perception of coordination difficulties. However, this paper shows how the interplay between managerial and non-managerial controls, plus important employee “work”, moderates tension and facilitates day-to-day lateral coordination at the patient-facing level.

This is a case-study, relying mostly on the findings of semi-structured interviews. Theoretically, the paper draws from previous insights on inter-organisational relations (but informing the focus on intra-organisational coordination) and an “institutional work” perspective.

Consistent with much extant literature, this paper reveals how non-managerial controls help to moderate tensions that could emerge from the coercive use of managerial controls. However, the authors also show a maintained influence and flexibility in the managerial controls at patient-facing levels, as new circumstances unfold.

The findings of this paper could generalise neither all laterally dependent spaces in hospitals nor patterns across different hospitals. The authors recommend future research into the dynamics and interaction of managerial and non-managerial controls in other complex settings, plus focus on the purposeful work of influential agents.

The paper has two primary contributions: extending our knowledge of the interplay between managerial and non-managerial controls inside complex organisations, where non-managerial controls reinforce rather than displace managerial controls, and highlighting that it is seldom just controls per se which “matter”, but also agents’ purposeful actions that facilitate coordination in complex organisations.

The purpose of this paper is to study the links between contextual changes, contract arrangements and resultant problems when changes in outsourcing regulatory requirements are applied to complex pre-hospital services previously characterized by relational contracting.

The study deployed a qualitative design based on interviews with key informants and extensive studies of documents. It is a longitudinal study of a procurement process taking place in a regional health authority covering the period 2006 to 2017.

A complex and longitudinal public procurement process where pre-hospital (ambulance) services are transformed from relational and outsourced governance to more formal arrangements based on legal and transactional controls, is described in detail. After several years, the process collapsed due to challenges following public scrutiny, legal actions and administrative staff resignations. The public body lacked procurement competencies and the learning process following the regulations was lengthy. In the end, the services were in-sourced.

This study is based on one case and it should, therefore, not be generalized without limitations.

One practical implication of this study is that transactional contracts are not optimal when core and complex services are produced in inter-organizational settings. In public sector health-care contexts, the role of informal and social controls based on relational exchanges are particularly applicable.

Acute health-care services essential to citizens’ security and health imply high asset specificity, frequency and uncertainty. Such transactions should according to theory be produced in-house because of high agency costs in the procurement process.

The paper contributes to the understanding of how the public procurement process can itself be complex, as managerial challenges and solutions vary along several dimensions and are contingent upon external factors. In particular, the study increases knowledge of why the design and implementation of outsourcing models may create problems that impede and obstruct control in a particular public sector context.

This paper seeks to explore the legitimacy of budgets as management control processes in hospitals after comprehensive reforms were implemented in the Norwegian hospital sector in 2002.

The paper employs qualitative interviews with top level clinical managers in three large hospitals.

The study shows a variety of practices among the clinical managers as to management control adjustments. The managers use different strategies in order to cope with the budget frames.

This paper contributes to the current debate and research relating to the budgeting and performance management practices in hospital settings.

These findings contribute to contextual knowledge that is relevant in understanding the diverse practices of clinical managers in hospitals as complex service producing organizations.

The findings give information to decision makers as to the diversity in management practices within knowledge intensive organizations.

The paper challenges the idea that the strategies used by managers can be understood by the concepts of the means‐end rationality prescribed in most of the reforms introduced into the hospital sector.

The purpose of this paper is to discuss the dilemma that exists between the aims of public sector reforms and the ways organisations adjust to the management control reforms.

To study the research purpose, empirical data were collected from Norwegian Regional Hospital Enterprises. The aim was to describe how these institutions have chosen to implement formal and informal mechanisms of control for coordination and management of hospitals.

The results indicated a comprehensive map of the different formal and informal adjustments to radical institutional reform changes. The reform strategies were met with a mixture of intended adjustments, partly realised ambitions and ignorance in the organisations, and the change towards accrual accounting system was found to have reversed effects compared with the original ambitions.

This study was based on a small sample of organisations and interviews. The dimensions were somewhat crude, and the findings can be generalised reliably only to the population studied here. More research is needed for further explorations of these findings. The study reveals as similar with prior macro level institutional research a complex view on the implications of government initiatives as only one of many potentially powerful actors in such regulatory processes.

This work adds to leaders' understanding of how intended governmental strategies follow diverse paths of implementation.

These results provide useful support of prior findings as to the deeper understanding of why organisations that are exposed to the same reform initiatives, turn out to behave differently.

The purpose of this paper is to provide insights into the process of the accounting system change as a part of a larger reform initiative taking place in Norway. The research context is the national network of hospital enterprises.

The paper uses an archival‐based case approach of official documents (between 2000 and 2009) to study the formal layers of accounting practices.

The accrual accounting information signalled major management control problems, but the hospital owner, the state, did not take action to solve these problems during this period. The contracts between the state and hospital enterprises were characterised as principal‐agent relationships. However, different accounting techniques were mixed in the contracts between the parties, indicating hybridisation of accounting systems.

The authors did not study the perceptions and practices of key actors and this is a limitation of the study.

The findings are likely to be useful for practitioners and researchers to gain knowledge on the implementation of management reforms in public sector service organisations.

This paper contributes to our understanding of the diverse processes within which public sector reforms are taking place. The main contribution is a discussion of the diversity in accounting system changes.

The purpose of this paper is to discuss why public sector reforms hybridize during implementation processes, consequences on accountability relations and practitioners’ and policymakers’ reactions to these changes.

The paper considers experiences from three initiatives related to the governance reform in the Norwegian hospital sector. Data were collected via interviews and document studies, and all three cases were longitudinal studies.

Unexpected consequences of reform initiatives and contextual changes are causing controls to hybridize and having profound effects on accountability relations. However, the gradually alignment of controls in a dynamic pattern of hybridization enables the balancing of conflicts in the chain of accountabilities. Hybrid controls are observed to emerge as stronger than the initial ideal control models. The longitudinal studies of control hybridization illuminate the sector’s survival in the long run, as they allow for adaptation to changes in contexts.

This work augments leaders’ understanding of how governmental strategies may follow diverse paths and yield results that diverge from intentions. Narrow accountability bases inhibit the government from implementing political decisions through agencies. Conversely, agents must relate to direct control from authorities. The predictability of agents’ decision space is reduced, and the control process becomes more ambiguous.

Through connecting what happens in agencies with accountabilities in the political level, it is possible to study the flexible nature of accountability relations and why controls hybridize. The paper underlines the need for longitudinal studies to describe complex patterns of reform initiatives.

The aim is to depict the effects of the rural-urban transformation visible in most western societies during the last few decades by examining the Swedish-speaking part of Finland, a geographically divided region kept together by a common language and culture. Everything from the remotely rural to the very central urban is represented here, as well as all possible types of outcomes of the post-industrial urbanization process: growing metropolitan centres, suburbs and commuting areas, declining smaller regional centres, counter-urbanization, and both viable and declining rural areas.

Population mobility may upset the formation (or preservation) of communities, and while these are vital for any sound and well-functioning society, we see a sense of community as especially crucial for the survival of minority populations. The empirical study consists of an overview of demographic trends during the time period from 1980 onwards to 2012, and in parallel, an overview of mobility patterns between urban and rural areas as well as of commuting.

The late modern trend of counter-urbanization is visible in our material, but still, while this does not extend outside the narrow commuting area, counter-urbanization may not be comprehended as a major trend in the Swedish-speaking regions. The main finding is the effect on communities of urbanization and counter-urbanization depicted by the ability to ‘live in Swedish’ in the different types of areas on the rural-urban scale. The study shows that while an area seemingly thrives, with evidence of population growth and in-migration, a high level of mobility may still hurt the prerequisites for community formation.