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

The purpose of this paper is to discuss the dilemma that exists between the aims of public sector reforms and the ways organizations 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 realized ambitions and ignorance in the organizations, and the change towards accrual accounting system was found to have reversed effects compared with the original ambitions. 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.