Same reform – different practices? : How regional health enterprises adjust to management control reforms

Purpose – 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. Design/methodology/approach – 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. Findings – 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. Research limitations/implications – 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. Practical implications – This work adds to leaders' understanding of how intended governmental strategies follow diverse paths of implementation. Originality/value – 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.