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The purpose of this paper is to understand how changes in technological devices, implemented to increase productivity and enhance performance are translated by medical professions in their clinical work. As organizations become more technology dependent by digitalization, deeper understanding of change processes will enhance change outcomes.

A case study based on interviews, observations, on site and document analyses is undertaken to study the use of electronic speech recognizer (SR). An actor network theory (ANT) approach is used to address practice.

Doctors diversely adjust to the new technology. The use of the SR technology was negotiated and translated by the doctors. The technology was continuously re-designed and interacting with the human actors. In the translation process, powerful actors (doctors) influence outcome of changes, and thus, they affect the effectiveness of the change initiatives.

The theoretical approach enables a detailed and rich understanding of the sociology of technology. Future research should go deeper into case studies in other contexts.

Technology is not deterministic entities, and politicians and managers should pay attention to how technology interact with key actors in implementation of system (technology) changes. The design and use phases implicate on the effect of such changes.

In order to successfully manage change processes, powerful actors should be motivated to actively participate in the design and the implementation phases in order to design and redesign the functions and roles of technologies.

The theoretical approach (ANT) addresses technology according to the concept of sociomateriality. This approach enables understanding technology, people and organizations as entangled (integrated). The theoretical concepts developed knowledge to gain deeper and wider understanding of the role of technology in managing of performance and productivity initiatives.

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.

The purpose of this article is to assess the continuing relevance of Olson et al.’s (1998) four primary concerns regarding the future development of New Public Financial Management (NPFM) in public service organizations. A particular focus is on understanding changes in the formal systems governing the performance management of universities across different “soft-NPFM” national contexts as well as the identification of successful strategies to mediate those four concerns.

Changes in the formal systems governing the performance management of universities in three European countries – Estonia, Finland and Norway – are reviewed in their historical contexts. Methodologically, this article is based on a content-driven analysis of documents, reports and scientific literature, supplemented by the collective memory of the co-authors.

“Warnings” have materialized quite differently in the three countries due to unique “national filters.” These filters are represented by different understandings of how universities are defined in terms of their governance and ownership, such as whether the universities are agents of the state or independent accounting entities with their own legal rights. These “national filters” seem to affect how NPFM is translated into the formal systems governing the performance management of universities.

This article contributes to the literature by examining how some countries and their governments manage to achieve “selective complementarity” of different reforms and trends. This complementarity helps to avoid the “dysfunctional effects” and “extremes” of NPFM.

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 hospital sector in Norway has been continuously reorganized since 2002 and the reforms have created organizations that are functionally/vertically controlled, whereas the production lines are coordinated on a process or a lateral basis. The purpose of this paper is to focus on both the perceived functional vertical control and horizontal controls within and between the local hospitals and the regional administrative levels.

A national survey study, complemented with interviews of some key informants and document studies.

The study shows that the functional and vertical lines of management control are perceived to be operating according to the traditional views of management control. The study indicates that the horizontal tasks are not very well implemented, and we did not find interactive and lateral uses of management control systems for managerial purposes.

New control problems arise when services are to be coordinated between autonomous units.

The paper focuses on the control problems found within the horizontal, flat relationship between production units in hospitals; new organizational structures have emerged where lateral relations are important, but traditional control practices follow functional, vertical lines.

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 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.

This paper presents a study which goes beyond the process of constructing performance measures in hospital Intensive Care Units (ICUs). The making of input-output measures in ICUs should be based on richer information than statistics normally found in the hospitals' patient administrative systems. A study of national sample of ICUs was conducted in Norwegian hospitals to analyse the relations between abstract and more concrete measures of unit performance. We found that there are not necessarily conflicts between abstract perceptional measures and more concrete efficiency measures in high-reliability organisations like ICUs. Reliable performance requires a well-developed collective mind to form an attentive, complex system tied together by trust. To improve health care management more attention should be directed towards the practical implications of the interrelationships between different elements of performance measures.

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.