Abstract
This study aims to depict a failed strategic change initiative in a Turkish public hospital by means of an action research and it strives to explain critical factors underpinning the failure, thereby proposing how such factors should be tackled with for similar initiatives elsewhere. The study calls attention to the recent challenges ongoing in the environment of hospitals, which urge them to take on a more strategic focus. In this vein, we discredit accreditation based systems, which emphasize monitoring resources and propose a capability-focused strategic management model for hospitals. A hybrid action research protocol, which combines both traditional and participatory action research methodologies in its design, is employed to formulate and implement the model in a public hospital. The phases of the project and obstacles faced during these phases are discussed. The findings suggest that although the model offers significant potential for competitive success and better resource efficiency, path-dependent characteristics of the public sector governance in Turkey have impeded the adoption of the model in our case. Both macro-systemic characteristics related mainly to the Turkish national culture and management of public institutions and situation-specific characteristics, such as top management's decision making orientation, professional norms and patronage relationships have blocked the way for the aspired transformation despite positive attitudes of and support from higher order public authorities and internal professional groups.
| Original language | English |
|---|---|
| Pages (from-to) | 353-370 |
| Number of pages | 18 |
| Journal | Systemic Practice and Action Research |
| Volume | 23 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 2010 |
Funding
Concomitant to the transformation of healthcare systems in Western settings, the foundations of change in Turkish hospital field were laid in the beginning of 1990s, when a small number of high quality private hospitals began to emerge. The emergence of private hospitals was important because hospital sector of Turkey had traditionally been a public domain and strongly controlled by the state or state-controlled authorities (Aksoy 2007). In the beginning, these private hospitals were focused on a niche in the hospital market, which involved a relatively small segment of patients with high income and high expectations of service quality. The emergence and rapid dissemination of these private hospitals signalled that a new business model other than publicly controlled hospitals—either governed by the Ministry of Health, public universities or charity foundations—was viable. Yet, the major impetus of change for the field of hospitals was after 2001, when a major economic crisis hit Turkey. Like other less advanced countries with a high trade deficit and high overall national debt, an orthodox economic retrenchment policy was introduced in 2002 with the aids from World Bank (WB) and International Monetary Fund (IMF). Since Turkish public healthcare system was diagnosed by the WB and IMF experts as the most problematic field in terms of economic efficiency, a set of directives have been launched to correct this deficiency. As a result of this initiative, the ‘‘Healthcare Transition Project’’ was launched in 2003 under the auspices of 59th cabinet and with approximately 50 million € financial support from the WB (World Bank 2004).
Keywords
- Capability
- Healthcare management
- Public hospital
- Strategic management
- Turkey
