Abstract
This article examines how the adoption of a dialogic accounting approach influenced the features of and the processes associated with the design and implementation of two successful performance measurement and management (PMM) systems at a large public teaching hospital. Findings report on data from 87 semi-structured interviews. The adoption of a dialogic accounting approach fostered the tailoring of the PMM systems’ features to the hospital and to its departments, encouraged the bottom-up involvement of staff, and helped to manage the tensions and paradoxes that arose during the design and development of the PMM systems. The article advances the research on public governance and accountability by providing one of the first empirical accounts of how the adoption of a dialogic accounting approach to PMM fostered the internal legitimacy and effectiveness of the PMM systems, which in turn reinforced the adoption of dialogic accounting and the continuous improvement of the PMM systems.