The article presents selected management instruments implemented in University Hospital in Bydgoszcz as a result of internal institutional changes connected with new institution -department manager. The compatibility of internal institutional order and proper management instruments box is a fundamental requirement for improving management processes. The case of University Hospital in Bydgoszcz shows the positive impact of internal institutional changes on the managerial decision making processes. The final effect of institutional changes depends on top management experience and competences and it is a very important source of competitive advantages. The compatibility of an internal institutional order and proper management instruments is required.
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