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This article sheds light on the reasons for practice variation in internal auditing (IA) introduction and development. From a policy perspective, the article’s findings highlight the relevance of accounting and accountability reforms as a crucial step for developing a new ‘awareness’ of the importance of internal controls and illustrate how IA can provide assurance on the internal control system. A further implication is that there is no ‘one-size-fits-all’ solution because different contexts need different IA models to mitigate the power and interests of the actors involved to ensure that IA is effective in terms of day-to-day activities.

What are the determinants of internal auditing (IA) introduction and development? Evidence from the Italian public healthcare sector