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One of the latest trends within public administration and healthcare organizations (HCOs) is process orientation, often in the shape of Lean management. The purpose of this study is to expand our understanding of process orientation of HCOs and the more specific aim is to investigate what measures are taken to re-frame the HCOs to include the process dimension.

This empirical study is based on 67 interviews and 20 meeting observations.

The main observation in this study is that introducing process-oriented management solutions is about disconnecting and cutting-off existing links. The authors see how attempts are made to cut-off links to the logic of functional specialization, the autonomy of the professional worker, equal treatment of patients and other objectives.

This study adds to and expands previous studies that have problematized the use of Lean-inspired ways of organizing in the public sector.

This study aims to examine the diffusion and implementation of trust-based management (TBM) in Scandinavian countries (Denmark, Norway and Sweden). TBM is a novel “anti-New Public Management (NPM)” innovation within the realm of New Public Governance (NPG), which asserts that leadership and control in public sector organizations should be practiced and designed based on the assumption that civil servants and employees in general are trustworthy. The research questions are as follows: How has TBM been diffused and implemented in Scandinavia? To what extent can the institutional logics framework increase understanding of similarities and differences between the Scandinavian countries (Denmark, Norway and Sweden)?

The authors designed and submitted surveys to the municipal directors of the three Scandinavian municipal populations, thereby producing a unique cross-country dataset on TBM diffusion and implementation in Scandinavia (Denmark, Norway and Sweden).

The authors' study shows that TBM has diffused widely among Scandinavian municipalities and has developed into a municipal-level concept across policy fields and sectors. While Denmark stands out as an earlier and more decisive TBM reformer, the results show that similarities in the diffusion and implementation of TBM in Scandinavian countries are more apparent than the differences.

This study contributes to the public management literature and research on anti-NPM and NPG concepts by being the first wide-scale empirical study of TBM diffusion and implementation in the Scandinavian municipal sectors.

The purpose of this paper is to create knowledge about what factors explain the design of control systems for contracted public services.

Questionnaire data analyzed with structural equation models.

Legitimacy-seeking is the most important driver in explaining intensity in control of contracted public services. Competition increases the intensity of control which is opposite to standard transaction cost reasoning. Coordination requirements do not affect the design of control systems for contracted public services.

The study suffers from limitations in the form of the use of perception and questionnaire data and imposes restrictions on empirical generalization.

Supplier competition may add control costs rather than lower them. The strong focus on stakeholder alignment may induce more intensive control than necessary for supplier alignment.

The authors add important knowledge on the determinants of control system design for contracted public sector services. The authors conceptualize and measure the control system in use in a more compelling manner than previous research.

In the last decade, greater attention has been paid to the role of management accounting and control (MAC) in making professional organizations more horizontal. The authors argue that earlier research has not shown how the interrelatedness between professional identities and MAC influences attempts to make organizations more horizontal. In this paper the authors respond to the call for more research on the relationship between horizontalization and accounting and control. The purpose of this paper is to contribute to the emerging literature on the relationship between accountability arrangements and professional identities.

Theoretically the authors have an actor-network theory (ANT) approach. Empirically, the authors followed two episodes where actors at top management levels in two Swedish health care organizations introduced horizontalization.

The two episodes support the view that the role of MAC when making professional organizations more horizontal is limited. Professionals dominate what happens at the operational level and they do not act on MAC rules and performance targets in opposition of their professional identity. However, in alliance with other interessement devices MAC may have a role in creating overflows, that is, pointing out imperfections in the existing frame. The authors noticed no signs that professionals developed hybrid identities as in previous research.

The authors apply ANT to move beyond the commonly used contingency and new institutional sociology perspectives.

In order to improve cooperation and collaboration between units, clinics and departments, many health care organizations (HCOs) have introduced process orientation. Several studies indicate problems in realizing these ambitions. The purpose of this paper is to explain and understand the success and failure of process orientation in HCOs.

The authors conducted three case studies and applied Actor-Network Theory as an analytic lens.

The realization of process orientation is hindered by neglect or resistance from physicians, who find the process targets to be of low medical priority. However, the authors also see that medical priorities are no stable entities but are susceptible to negotiations. Over time, process organization, process mapping, process measurement activities and the acting of enroled actors may have impact on medical priorities.

Contrary to previous research, the findings indicate that New Public Management may not be the main obstacle against processes, that accounting figures may not be hard to disregard and that the role of leadership is not paramount.

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.