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This paper tries to respond to the call of several Institutional Theory authors for studying the causal mechanisms for institutional change.

We found evidence that suggests professional logics that were in place within the public health sector over the years were challenged by the introduction of management accounting systems. Nevertheless, the power health professionals have within the public health sector maintained professional logics as prevalent comparing with the market logics that were behind the introduction of new public management practices such as management accounting systems. The study also showed how health professionals react to this change, especially how the introduction of activity-based costing enabled a higher level of legitimation of market logics before these professionals. Health professionals questioned their medical practices in a management efficiency point of view and tried to adapt themselves to a different equilibrium of forces between market and professional logics. This study adds value to other previous studies in the health sector.

Evidence collected encompasses semi-structured interviews, observations and internal archival data from a public hospital. Directors, physicians, nurses, managers and accountants were among the interviewees. Some complementary documentary sources of public access, such as legislation, newspapers, and websites were also used.