• behavioural management accounting
• budget
• healthcare sector
• management control systems
• motivation

The healthcare system has been involved in many changes in recent years. Since the coming of New Public Management (Mercurio and Martinez, 2010), health organizations have recognized the need for a more effective and efficient use of resources to enhance the organizational performance and the success of the entire national health system (Macinati and Pessina, 2014). To achieve this, the support and the engagement of clinical employees is essential in that they are responsible for the quality of care delivered to patients (Mosley, 2014; Bini, 2015). Alignment of organizational and physicians' goals is therefore crucial for enhancing the effectiveness of the health care system. In order to guide employees' behaviour, management control systems, as the budget system, have proven to be particularly effective (Malmi and Brown, 2008). Indeed, according to the behavioural management accounting research, the nature and shape of management control systems can influence relevant employees' behaviours and attitudes (as motivation).
According to behavioural accounting, participation and feedback may lay the foundation for a successful engagement strategy among clinical staff. Healthcare professionals' involvement in the budget process is of paramount importance for the effectiveness of healthcare organisations. Will participation and feedback to budget goals affect clinicians' motivation? Will this effect vary if the overall engagement strategy of the organization is taken into account? How the budget is perceived and used in healthcare settings? In this regard, are there any differences among professional roles? This research aims to answer these questions by taking into account the empirical evidence of the Tuscan healthcare system.