Suchergebnisse

Bu çalışma, 2003 sonrası Türk sağlık alanındaki kurumsal değişim sürecinde, Sağlık Bakanlığı ile Tabipler Odası ve sendikalar arasında yaşanan güç mücadelesinin zamanla nasıl bir seyir izlediğini ortaya koymayı amaçlamaktadır. Çalışmada, özel olarak değişen güç dengeleriyle beraber kurumsal girişimci olarak nitelenilecek AK Parti'li Sağlık Bakanlığının ne tür güç mekanizmalarına, muhalif aktörler olarak da Tabipler Odası ve sendikaların ne tür direniş taktiklerine başvurdukları anlaşılmaya çalışılmıştır. Bunun için doküman incelemeleri ve kurumsal aktör temsilcileri ile görüşmeler yapılmıştır. Elde edilen verilerin Lawrence vd.'nce (2001) tanımlanan güç mekanizmaları ve Della Porta ve Andretta (2002) tarafından açıklanan direniş taktiklerine göre sınıflandırılmasıyla, kullanılan güç mekanizmaları ve sergilenen direniş taktiklerinin güç dengelerine paralel olarak değiştikleri ortaya çıkmıştır. Araştırma bulguları, genel olarak, kurumsal girişimcinin güçlendikçe olaysal güç mekanizmalarından sistemik güç mekanizmalarına doğru, muhalif aktörlerin de, güç kaybettikçe şiddet seviyesi düşük direniş taktiklerinden şiddet seviyesi yüksek taktiklere doğru bir seyir izlediğini göstermektedir ; This study aims to find out, during the institutional change occurred in the Turkish health care field, how the power struggles between the Ministry of Health as an institutional entrepreneur and the Turkish Medical Association as well as the Unions as opposing actors changed during the period of 2003-2014. The study specifically focused on understanding the kind of power mechanisms used by the Ministry of Health ruled by Justice and Development Party and the resistance tactics exhibited by both the Medical Association and Unions as opposing actors, along with changing power balances over years. For this purpose, we carried out document examinations and interviews. Categorizing the data based on power mechanisms identified by Lawrence et al. (2001) and resistance tactics described by Della Porta and Andretta (2002), we found out that the power mechanisms applied by the Ministry of Health and the resistance tactics displayed by opposing actors have changed in conjunction with the changing power levels and balances. The research results specifically show that institutional entrepreneur, as getting stronger in the field, would rather more systemic and less episodic mechanisms while opposing actors tended to display higher level intensity resistance tactics as they lose their power over years.

AbstractWe set out to explore the practice-level cognitive structures and associated practices characterizing the daily routine work of physicians by conducting a qualitative study in the Turkish healthcare field, in which a recent government-led healthcare reform was implemented causing logic multiplicity. Contrary to the accumulated knowledge in institutional logics literature, a bulk of which suggests that actors craft and enact various practices in managing plural and at times conflicting institutional templates strictly within the confines of higher order societal logics, this study shows that while ground level actors may not exercise complete freedom and maneuverability in relation to pre-established social structures, they do incorporate unconventional schemas of action; namely rogue practices, into their embodied practical activity, which over time become routinized in their day-to-day work lives. Unraveling the dynamics of micro-level practices of highly professionalized ground level actors as they pertain to atypical logical orientations substantially advances our understanding of the unknown or unseen side of how and under which conditions certain or various combinations of institutional logics are employed during day-to-day activities.

AbstractThis study attempts to understand to what extent the actual priority setting in the municipalities of Türkiye as a developing country aligns with idealised rational models based on theoretical principles and successful cases in developed countries. For that purpose, the study examines the cases of priority‐setting process of service provision in Turkish municipalities through an exploratory qualitative research method involving focus group meetings with the representatives of 30 municipalities and field observation in two municipalities. The findings reveal key aspects of the prioritisation process, including approaches taken by the municipalities, citizen and stakeholder engagement, the role of managers, criteria used for the assessment of alternatives, and evaluation methods. The analysis identifies two distinct patterns, that is the idealised rationalist versus pragmatic, in all the key aspects examined. These findings contribute to a better understanding of what aspects of idealised rationalist and pragmatical decision‐making processes are distinct from each other, and to a more comprehensive international perspective in public organisations, especially in which top manager such as the mayor is elected into office in developing countries. The study cautions against uncritical acceptance of oversimplified rationalistic as well as universalistic assumptions behind priority‐setting models and advocates for a more substantiated and contextualised understanding of decision‐making processes.Points for practitioners
Adopting a priority‐setting approach (technique, method, or criteria) necessitates considering the unique conditions and challenges of one's organisation and the local context. It is imperative to blend theoretical principles with practical realities to achieve optimal decision‐making and superior outcomes.
Priority setting in public organisations of developing countries diverges from idealised rational models used in developed countries due to contextual factors like culture and limited resources. Policy advisors from international organisations and developed countries should endorse knowledge and experience sharing that acknowledges both ideal and practical realities. Concurrently, practitioners in developing countries must critically assess the applicability of advised models to their specific context before adoption.
If the mayor takes a dominant role in the priority setting that outweighs institutional strategies and priorities, effective prioritisation among alternatives may be hindered. To rebalance power, it is crucial to foster an organisational culture that embraces participative decision‐making and professionalism and implements mechanisms such as auditing, transparency, and accountability.