The focus of this article is on the contribution made by the project management office (PMO) to organizational performance. It explores the particular case of a PMO dedicated to a major organizational transformation within a Canadian university hospital. The national government has asked hospitals to provide strict control over their budgets through implementing strong governance mechanisms. How can PMO performance be assessed within this context? Perception of two different groups has been analyzed within a competing values framework, allowing for a combination of four different performance conceptions. Results show certain similarities in the barriers to PMO performance but, most importantly, they reveal that between the two groups a paradox exists regarding what is valued in PMO performance. Results bring empirical evidence of the application of the competing values framework to the health care sector, but also to a wide variety of industries, public or private.