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Reforms of the public health-care sector have emphasised the role of management accounting (MA). However, there is little systematic evidence on its use and benefits. To fill this gap, we propose a contingency-based model which addresses three related issues, that is, whether: (i) MA use is influenced by contextual variables and MA design; (ii) top-management satisfaction with MA mediates the relationship between MA design and MA use; and (iii) financial performance is influenced by MA use. A questionnaire was mailed out to all Italian public health-care organisations. Structural equation modelling was performed to validate the research hypotheses. The response rate was 49%. Our findings suggest that: (i) cost-containment strategies encourage more sophisticated MA designs; (ii) MA use is directly and indirectly influenced by contingency, organisational, and behavioural variables; (iii) a weakly significant positive relationship exists between MA use and financial performance. These findings are relevant from the viewpoint of both top managers and policymakers. The former must make sure that MA is not only technically advanced, but also properly understood and appreciated by users. The latter need to be aware that MA may improve performance in ways and along dimensions that may not fully translate into better financial results., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

This study explains the process ‘'how'' organizational accounting practices, such as budgetary participation, influence medical doctors' perceptions and beliefs associated with their hybrid role and what the consequences are on their performance. Building on social cognitive theory, we hypothesize a structural model in which managerial self-efficacy and role clarity mediate the effects of budgetary participation on performance. The data were collected by a survey conducted in an Italian hospital. The research hypotheses were tested employing a path model. The results suggest that role clarity and managerial self-efficacy fully mediate the link between budgetary participation and performance. From a managerial viewpoint results suggest that organizations that invest in budgetary participation will also affect individual beliefs about the perceived benefits of participation itself, since an information-rich internal environment allows employees to experience a clearer sense of direction through organizational goals. According to our results, organizations that seek self-directed employees should pay attention to the experience the medical managers acquire through budgetary participation. In fact, this event influences the employees' mental states—and specifically provides them with information needed to perform in the role and enhance their judgment of their own capabilities to organize and execute the required course of actions—which take on internal psychological motivation to reach performance levels. [ABSTRACT FROM AUTHOR]