This paper analyses the impact of the institutionalisation of governance and budgetary policies on the accountability of organisational actors from an institutional and critical realism perspective. The study extends the framework by Burns and Scapens (2000) to critical realism. Findings from field studies conducted in two public hospital districts in Finland show two institutions of budgetary governance: the political and the technical. Accountability practices depend on how the institutionalised policies have reduced or increased the gaps between the real, the actual and the empirical domains of reality of the organisational actors involved and the governance policy that prevails at a given domain of reality. The use of budgetary information as a tool of governance and accountability in the empirical field of the study cannot be taken for granted.