“…Even if there's a consolidated generalist literature recognizing that budgetary participation plays a key role in influencing managerial performance, through its beneficial effects on mental states, attitudes and behaviors [66,100], the drivers of the predisposition to participate in the budgeting process have still remained relatively unexplored [22,65,99]. In particular, there are few studies focusing on the role played by subordinate's perceptions of superiors or contextual factors [19,30,113], especially in BMA research in the context of PHOs based on budgetary participation approaches [3,62,88,95,110]. In the Italian context [11,55,107], the main contributions have explored its beneficial effects on influencing doctormanagers' attitudes, motivation, and subsequent behavior and performance within different theoretical frameworks [13,61,63].…”