Reforms and clinical managers' responses: a study in Norwegian hospitals

Purpose – 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. Design/methodology/approach – The paper employs qualitative interviews with top level clinical managers in three large hospitals. Findings – 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. Research limitations/implications – This paper contributes to the current debate and research relating to the budgeting and performance management practices in hospital settings. Practical implications – These findings contribute to contextual knowledge that is relevant in understanding the diverse practices of clinical managers in hospitals as complex service producing organizations. Social implications – The findings give information to decision makers as to the diversity in management practices within knowledge intensive organizations. Originality/value – 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.