The complementary effects of formal and informal budgetary performance feedback on doctor-managers' responsibilities

Background: The reforms that have affected public health care organizations have changed the tasks and responsibilities of physicians heading operational units, who have become doctor-managers. This hybridization makes doctor-managers vulnerable to role ambiguities, with possible dysfunctional effects on their managerial behaviors and performance. The enhancement of different sources of budgetary performance feedback (BPF) and perceived organizational support (POS) can help them reconcile their managerial and clinical professional domains. Purpose: Rooted in psychology-based budgeting research, this study aimed to show the role of doctor-managers' perceptions of BPF by examining the complementary effects of formal and informal BPF on POS and their satisfaction with the budget-holder role. Methodology/Approach: We collected self-reported data by administering questionnaires to a sample of doctor-managers from Italian public health care organizations. The hypotheses were tested using a linear regression model, clustered at the hospital level. Mediation analysis was used to test the mediating effects of POS. Results: Findings showed that formal and informal BPF perceptions positively influenced POS and satisfaction with the budget-holder role. Further, POS mediated the BPF–role satisfaction link. Conclusion: The study adds to the limited research on the individual-level benefits of perceived formal and informal BPF as complementary mechanisms for improving doctor-managers' attitudes toward the budget-holder role. Practice Implications: Topmanagement and controllers should develop budgeting practices that consider the psychological factors related to the complementary functioning of formal and informal BPFs. These factors may support doctor-managers in meeting their responsibilities as budget holders and mitigate role ambiguities.