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Implementation process of management control systems in the municipally owned hospitals: in the case of Nagasaki prefectural hospitals in Japan

The purpose of this paper is to describe and explore management reforms in the municipally owned hospitals in Nagasaki prefecture, Japan, based on 'levers of control' framework (Simons, 1995). The hospitals are changing their strategy through specialising in a particular medical function and streamline of management. At this writing, these reforms are going on. The case is limited in the stage of complete application of Local Public Enterprise Law. However, we could reveal partially how four Management Control Systems (MCSs) are installed and work together for implementing the strategy in one of the hospitals. Finally, discussions and limitations are showed.