idiosyncrasies of personalities and differential perceptions and experiences on the part of interviewees. In all such cases, I was able to refine the manner in which the data were collected either by re-posing the question or by posing it differently, or to attribute the contradiction to personality and temperament. The total number of interviews carried out with ALSM members was 24, averaging three hours in duration.

The second most important source of data were seven years of minutes of meetings that took place twice per month during the first 4 years, and with decreasing frequency after that. A total of 143 documents averaging three typed pages in length (excluding annexes), these minutes were methodically and professionally kept, and constitute a rare and valuable window onto the evolution of public sector institutions.<sup>18</sup> Similarly methodically kept were a treasurer's ledger, purchase orders, and files of receipts, all of which were used to produce audits and annual reports by a professional accounting firm. The ALSM also kept detailed personnel rosters and employee absence information. Also used in this paper were various reports written by HDB and MOH/World Bank staff on HDB and on other public hospitals.

In addition, I conducted a total of 25 interviews with HDB middle managers, the former and current director, and doctors and nurses currently or previously connected with HDB. I carried out 20 interviews with MOH central administration staff from the Procurement, Public Hospitals, Medical Care, Accounting, and Directorate General divisions. Finally, I interviewed the two forner and current Ministers of Health and a total of 4 of their advisors.

In Lebanon, there are 17 public hospitals in all, of which six are being corporatized. Because implementation of the reform only began last year, and because of lack of data in public hospitals in general, experimental design using IIDB as a "control" is not feasible. Instead, my examination of HDB's trajectory is designed as a "reflexive comparison" that compares HDB to itself before and after its self-induced corporatization program, using time-series quantitative and qualitative data from 1988 until 1997. Given that HDB was the leading edge of change in the Lebanese public hospital sector -- by definition a non-representative case -- the objective behind this research is neither to suggest that the case be replicated not to generalize from the case to the population. Instead, this research seeks to discern key elements that can inform the theory, and to generalize from case to concept (Yin 1994), in particular the institutional design as defined by Law #544 and its Implementation Decrees.' 9 18 Each set of these minutes begins with a list of members present, then lists an agenda, then itemized discussions of the agenda, and concludes with a financial report from the treasurer. 19 This paper adopts North's (1990) distinction between "institutions" and "organizations". Institutions are the formal and informal rules that shape interaction. They range from constitutions, to laws, to common practice to corporate culture (Kreps 1993). Organizations are groups of individuals bound by some common purpose to achieve a given set of objectives. They include political, economic, social and educational bodies. In this paper, a hospital is an organization. The law and decrees governing the operation of the hospital are a set of institutions.

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