Hospital accreditation systems and salience of organisational tensions

Purpose - This study examines how an externally imposed management control system (MCS) – hospital accreditation – influences the salience of organisational tensions and consequently attitudes of management towards the system. Design/methodology/approach - Data are collected using a case study of a large public hospital in Spain. In-depth interviews were conducted with 27 senior and middle managers across different functions. Relying on the organisational dualities classification in the literature, tensions are unpacked and analysed. Findings - Evidence is presented of how hospital accreditation increases the salience of organisational tensions arising from exposition of the organisational dualities of learning, performing, organising and belonging. Salient tensions were evident in the ambivalent attitudes of management towards the hospital accreditation system. Practical implications - The role of mandatory external control systems in exposing ambivalence and tensions will be of interest to organisational managers. Originality/value - The study extends the management control literature by identifying an active role for an external MCS (accreditation) in increasing the salience of organisational tensions and triggering ambivalence. Contrary to the prior literature, the embedding of both poles of an organisational duality into the MCS is not a necessary precondition for increased tension salience. The range of attitudes towards MCSs beyond those specified in the previous literature (positive/negative/neutral) is extended to include ambivalence.