Implementing management tools in Turkish public hospitals: the impact of culture,politics and role status

The government of Turkey has attempted to substantially improve the management of its public hospitals. However, an analysis of the performance of the quality certified hospitals finds only minor improvements. This study seeks to explain these disappointing results by interviewing 46 hospital managers and employees about the successes and failures of the management reform effort. The interviews suggest that traditional Turkish organisational culture often hinders attempts to decrease hierarchy, but, more positively, it also encourages the use of frontline teams and group rewards. Moreover, Turkey's hybrid system of allowing public doctors to maintain private practices has provided doctors with both the resources and the incentives to fight management reform efforts. Finally, organisational decentralisation in Turkey has evoked fierce political opposition, ironically even from many pro‐modernising forces that fear it could increase the power of Islamic fundamentalists. Turkey's experience suggests a number of broader points about management reform in non‐western societies. It suggests that decentralisation can often impede, rather than strengthen the other aspects of management reform; that a hybrid market organisation is often harder to move toward market efficiencies than a purely governmental one; and that national cultures should help guide the order in which reform tools are implemented. Copyright © 2008 John Wiley & Sons, Ltd.