This study examines the interplay between the use of technical standards and institutional behaviour in the public procurement of medical devices in Romania. It is based on an analysis of a longitudinal dataset of approximately 600 procurement files (2019–2024), to identify the various levels of maturity and the actual trends in the Romanian ecosystem. The paper offers in the end potential solutions for closing the identified gaps and reducing performative compliance. Quantitative findings reveal a 225% surge in medical management contracts during the 2021 pandemic peak, which authors consider to be a manifestation of reactive isomorphism, followed by a significant maturation pivot in 2022. The nearly perfect correlation between Public Administration and County Hospital procurement cycles suggests a tendency towards mimetic isomorphism ("copy-paste" logic) which is proved also by the prevalence of "Ghost Standards" (withdrawn or obsolete references) in the procurement documentation, demonstrating a tendency towards performative compliance to mask institutional void. The article concludes that closing the standardization gap and achieving solid maturity in the public procurement system requires a transition from performative "check-box compliance" towards a substantive quality framework. By leveraging national technical repositories and expertise, based on the already increasing performance in certain segments of the public procurement system, Romania can move forward maintaining the overall framework, but investing more in knowledge management and avoiding performative compliance.