Abstract This article analyzes the process of institutional change, focusing on endogenous, exogenous and systemic processes. Scholars usually analyze institutional change considering endogenous and exogenous explanatory factors to talk about the direction and outcomes of the changes. In addition to these two factors, this paper proposes a third one. This paper proposes that the process of institutional change should be understood in terms of systemic variables and should take into account the interactions between institutions as a relevant factor in explaining the veto or promotion of institutional change. Based on qualitative evidence gathered from interviews with key accountability actors in Brazil, the paper discusses the incremental changes that occurred in the Brazilian accountability institutions. We demonstrate that, despite these incremental changes, the final result in terms of institutional change was not a broader systemic change with greater cooperation and coordination of control activities between accountability institutions. Accountability processes are understood as part of a dynamic system, under which competition and cooperation are part of the action repertoire of accountability actors and used differently depending on the situation.
INTERROGATING INSTITUTIONAL CHANGE: ACTORS' ATTITUDES TO COMPETITION AND COOPERATION IN COMMISSIONING HEALTH SERVICES IN ENGLAND