BackgroundOver the years, public procurement has proved difficult. There are several procurements that have caused major problems as a result of poor implementation. At present, there are insufficient studies done on procurement and purchasing processes, largely due to difficulties in obtaining good procurement data to analyze. However, some previous studies show that there are opportunities for improvement in the area and that it is common for money to be "wasted" in procurement and purchasing. It is therefore important to choose this particular topic. To investigate the subject, a research object with a specific procurement and purchasing process has been selected where there is a problem with purchases being made outside agreements, even though there are many products in agreements. Based on this process, the goal is to make both general and specific conclusions.  Purpose The purpose of this study is to investigate the underlying factors that lead to low contractual fidelity in public procurement and purchase in health care. Furthermore, the purpose is also to promote the knowledge development of fidelity to agreements. Contract fidelity refers to the ability to stick to purchasing on contracts.  Method This research report is based on a method triangulation between a quantitative part containing collected data from the research object, which is an organization with many different areas. This quantitative part is analyzed using the analysis program SPSS with different types of data analyzes. First, correlation tests have been used to present relationships between different parameters, but also to show that data is normally distributed. Furthermore, regression analysis has been used to measure individual impact from different variables. These regressions have had total purchase amounts and agreements as dependent variables. Furthermore, a qualitative part is also included in the form of interviews where the purpose is to broaden the understanding and identify additional parameters that may drive purchases outside the agreement. These interviews have been of a semi-structured design with a strategic selection of interviewees who the researcher believes contribute the most knowledge to the research. An important reason that there is both a quantitative and a qualitative part is because only a qualitative part can give an unreliable result as interviewees can provide incorrect information. The quantitative data becomes clear as it reflects purchases without the possibility for the buyer to hide something. The qualitative part thus also has an affirmative function in addition to its exploratory function. Finally, the above-mentioned empirical data are analyzed with appropriate theories selected for this particular research. It is these theories that through the report are called the glasses of research and are this research's unique way of looking at this type of problem.  Results The quantitative result shows that a total of 32.1% of the examined articles are purchased outside contracts. This corresponds to 26.5% of its total purchase amount. To investigate the relationship in the organization's purchasing parameters, it was examined how these correlated with the contractual parameter. Much of the correlation explained the natural connections in purchasing data, while the correlation between purchasing path and agreement was distinguished as this indicated that a certain purchasing path tends to drive purchases outside contracts. Furthermore, supplier data gave indications that it was a relatively low proportion of the total number of purchases from those from the organization that went through the purchasing department. It was also common for purchases to be made outside the contract with one supplier. The linear regression analysis with total purchase amount as a dependent variable indicates that unit price, number of purchase orders, purchase quantity and agreement turn out to be significant and that these can be said to affect the total purchase amount. In the logistical regression with agreements as a dependent variable, the significant parameters purchase quantity, number of purchase orders and unit price were found to have little or no impact on purchases on or off contracts. The purchasing route had a major impact, which indicates that this drives purchases outside the agreement. The qualitative result indicates that ambiguity, access to information and the ability to convey information means that purchases are made outside agreements. It also becomes clear that the information asymmetry that prevails in different relationships can be used to make decisions that are beneficial to oneself. Furthermore, shortcomings in the follow-up and the ability to get a clear picture of the purchasing process are perceived as a factor that purchases outside the contract may continue. It is not possible to follow up and discover purchases outside the agreement. The competence in the organization is also considered to be too low regarding, for example, purchases and agreements, which is also a contributing factor to lower contractual fidelity.  ConclusionUnit price, purchasing path, ambiguity, information asymmetry, relationships, signaling of information and lack of follow-up are all driving purchases outside the agreement. The problems and what basically cause purchases outside contracts are found on an overall level. It is based on information asymmetry. The reason for the information asymmetry can be linked to agent-principal relationships and signaling. Signaling can help solve the organization's problems. There have been limitations during the study, mainly due to time frames. Because a number of different strategic selections have been made through research, for example when collecting data where this affects both the number of parameters and the number of interviews. However, the study is still considered a contribution with a good result. These limitations lead to potential future studies where the development of this study with a broader empirical evidence is suggested as an example.