This article provides insights into organizational and accounting changes at Saint Anna’s Hospital in Ferrara (Italy). These changes were driven by a wider environmental change which occured in 1598 when the Dukedom of Ferrara was devolved to the Papal State. This brought about an institutional and political shift that affected the overall society and its main institutions, including the hospital. Research material was drawn from State and private archives, including the original sixteenth-century accounting books, statutes and organization manuals. The article adds to the sparse literature on accounting practices in non-Anglo-Saxon countries in under-researched centuries. More specifically it provides an internal perspective on understanding the definition of responsibilities among organizational levels as well as accounting development within Saint Anna’s Hospital both before and after an episode of significant institutional change.
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