The association between the use of management control systems and the effectiveness of performance management systems in hospitals

This study examines the association between the use of Management Control Systems (MCSs) and the effectiveness of Performance Management Systems (PMSs) in hospitals. Specifically, the study utilizes Simons' levers of control framework to examine the impact of the enabling use of controls (interactive and belief levers) and the constraining use of controls (diagnostic and boundary levers) on the achievement of PMS process outcomes and hospital performance. The findings indicate that the achievement of process outcomes (performance related and staff related) is affected by the enabling use of controls, with the achievement of staff related outcomes mediating the association between the enabling use of controls and hospital performance (medical facilities and effectiveness). In addition, both the enabling and constraining use of controls exhibited a direct impact on hospital performance. The study contributes to the management accounting literature by providing an insight into the role of MCSs and the importance of process outcomes in enhancing the effectiveness of PMSs in hospitals.