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Journal of the Academy of Hospital Administration

Hospital Administration Operations in Turkey

Author(s): Turkan Oguzhan*, Gurean Bebitglu*, Yusuf Ustu*

Vol. 16, No. 2 (2004-07 - 2004-12)

Key Words:

Hospital administration operation, Hospital indices, length of stay, bed occupency rate

Key Messages:

  • Home care programs are needed to be developed
  • In Turkey Hospitals average length of stay is 5.7 days1
  • However, bed occupency rates are 60.6%1 which Implies sub optimal utilisation


Even though preventive medicine is very successful, some people will be ill during their life. Therefore, they will need curative medicine, in other words hospital treatment. The health care services given by doctors, nurses and other health workers in hospitals have to be managed in an efficient and effective way. The health service quality, time management, response to patients' expectations, prevention from malpractice, updated treatment and so on, are very important while giving health services in hospitals.

Hospitals are complex to manage, where the highest caliber and best-informed management is required2. Hospitals must be "autonomous" and directors of the hospitals should be able to use their medical and administrative authority to the full extent. Health care professionals as managers and leaders should fulfill their responsibilities towards their patients. In additions to skilled human resources, a wide variety of physical equipment, buildings, and time are required management if they are to be used optimally.

Global Perspective

There are many differences among undeveloped, developing and developed countries' hospital management styles, but they are faced with similar problems on claims of patients. When a patient goes to a hospital, he/she expects good communication with doctors, nurses and officers, hopes equity and respect his/her believing and feelings, wants service quality given a smiling and humanity way, wishes solutions to his/her problems effectively in a short time.

For patient satisfaction, hospitals need different facilities. For managing these facilities, besides different committees, effective top team is a necessity in hospitals. Without an effective administrative team, no organization can function effectively and efficiently. Team and committees are the prime mechanism for both the consideration and implementation of policies and strategies. "Teams succeed when they are pro-active, well prepared and communicate well. An effective team can change strategy content in light of opportunities or threats, and environmental changes to be controlled interactively by team."

Without effective coordination, decision-making can become ineffective. Therefore, managers should be democratic, open- minded and they ought to give authority to their subordinates. According to management authors, managers who follow an "open-door" and "open-minded" policy gain time and find possibility for solving problems. Physicians must decide to invest for management how much time and energy, and they should take role on achieving to organizational goal2. All personnel who work in hospital should find possibility to take in decision-making process.

National Perspective: Turkey

In Turkey, the management of health services is very centralized. The central Ministry of Health organization is quite complicated and organized vertically, with some units responsible for certain types of services like primary health care services, some responsible for serving specific groups like mother and child care, and some dealing with specific diseases like tuberculosis, malaria and cancer. This results coordination problems. This centralize organizational structure continues to provinces and hospitals. There are few qualified health managers who took part in a management course and these are in appropriately recruited. Health management and decision-making are not based on information because of the insufficient data and unconfident statistics. Turkey need an improvement in management capacity within the health sector, and a reform on hospital care beside primary health care, through the establishment of autonomous hospitals to promote efficiency and effectiveness and competition between service providers. Qualified cadre managers will use modern management skills and have quality awareness when managing the health services.

Patients can apply to the hospitals without taking any referral from GP in Turkey, even though GP's are "gate-keepers". Nowadays there are health reform efforts called as "health transition project" supported by World Bank. With this project, family medicine system will be established and therefore new referral system will not let the patient go to the hospitals directly without consulting their GP's except emergency conditions. Emergency system in Turkey is totally different from most of other countries. Patient calls 112 for ambulance. General practitioners work in ambulances, in emergency 112 services and in hospital emergency services. There are very few specialist physicians working in this area. And also paramedic education is recently held in Turkey.

Recent Trends

In recent years, great development occurred in the field of the health human resources. The number of the Medical Faculties has increased. But quality of medical education is not increased and there is not any management lesson in faculty although after graduating medical faculty physicians have to work as managers.

Hospital Utilization Indices

In Turkey, time of staying in hospital is 5.7 days1. If home- care programs are developed or hospitals are differenced as acute and chronic disease hospitals, it can be reduced. And in the hospitals of Turkey, occupancy rate is 60.6%1. It means hospital beds are not used efficiently. Home visiting and home- care support centers have useful facilities for patient and both are a "support system" for hospital also. In Turkey, home care is not organized as legislative, on the other hand nurses who work in Mother and Child Care Centers and Primary Care Health Centers, visit especially babies and pregnant women at their homes for observing their health status.

If hospital risk management system works properly, it protects patients and health workers from medical errors, which can be fatal sometimes. Doctors and nurses should report their errors and accidents even the are minor. Voluntary incident reporting system reduces errors 5-30%, list of accident anticipated reduces malpractices 40-60% and occurrence- screening system also reduces medical accidents 80-85%. In Turkey, some private hospitals use total quality management and risk management systems, but these systems don't apply to the state hospitals yet. Though, there are some efforts to increase patient satisfaction like patient right regulations and quality improvement in hospitals.

Cooperation with other hospitals and with regional physicians is developing day by day and some training programs are planned for increasing relationship among physicians and hospitals. And also, there are some methods using for personnel motivation like giving rewards and certificates, parties, ceremonies, etc. in hospitals.

Hospital Organizations

The organizational chart of the hospital should be horizontal. In horizontal organizations, there is no problem as long as appropriate computer networks, open-minded management and educated workforce exist. There are many committees in hospitals like infection, emergency, surgery, laboratory, radiology, pharmacy, in-patient and outpatient, training of doctors and nurses, risk management and quality control committees.

If these committees work effectively and efficiently, and decision-making process in agreement with committee members takes less time, it would be very useful and the organization. "A group of clinicians working effectively together on management issues is far more powerful than a single voice and can often bring about major change."2 Doctors and nurses should take role on achieving to organizational goals.

If you put these committees on the horizontal chart of hospital it would create a matrix organization. According to authors, matrix organizations are non-hierarchical organizations where information is shared to facilitate functional coordination and in this type organization everybody is related with each other and learns something from them. Turkish hospital management system is organized vertically under authority of Heal Physician of Hospital.


A high quality health-care organization monitors physicians' performance with accurate data on clinical outcomes and patient satisfaction. The better-educated personnel give the better service and it causes client's satisfaction. It is required to change hospital policy from quantitative process to qualitative process and for quality management; hospitals ought to have six elements: "Philosophy, Vision, Strategy, Skills, Resources and rewards".


  1. Health statistics, The Ministry of Health, Turkey, 2003.
  2. Simpson J., Doctors and Management. Why bother?, BMJ, 1994 Dec 3, 309(6967) 1505-8

* Ministry of Health, General Directorate of Primary Health Care, Turkey

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