NPM Reforms and the Perception of Budget by Hospital Clinicians: Lessons From Two Case‐studies

This paper investigates how clinicians perceive managerial budgeting and how this affects clinical practice. To this end, case‐studies were conducted involving two Italian public hospitals. The results show that clinicians' commitment to organizational objectives was strongly enhanced by the use of the budget as a means to evaluate and reward clinicians' performance. One of the main lessons learned from this study is that aligning existing institutions to organizational objectives is the only way forward for effective reform implementation. Consequently, the challenge for future reforms is to deal with the search of balance between efficiency goals and existing institutions.