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This study examines the influence of some elements related to authority structures in public hospitals on the way that directors of clinical services (DCS) use accounting information tools (AIT) in their decision-making processes. We test seven hypotheses about factors that potentially influence the use of AIT in DCS decision making. One construct was original, and the rest were adapted from previous studies. The results partially confirmed the model: (1) the presence of a transformational leadership style in more senior doctors positively affects DCS's use of AIT; (2) the DCS used AIT for their decision making if they felt that their authority was based on expertise rather than position; (3) the more satisfied the DCS feel about the information characteristics of AIT, the more they will use AIT; and (4) the more the DCS perceived that those senior to them used AIT for management control, the more they used AIT for decision management.