“Old Habits Die Hard”: Formal Politicization and the Turnover of Public Hospital CEOs

This study investigates how formal politicization shapes the turnover of senior public executives. Using a dataset of 138 CEOs across 79 Italian public hospitals between 2017 and 2021, it examines the relative influence of managerial competence and partisan loyalty on the likelihood of CEO exit. Although both factors affect turnover, partisan loyalty emerges as the primary driver. Political stability significantly lowers CEO dismissal risk, even with weak organizational performance or limited managerial human capital, which plays a secondary role. These findings suggest that NPM reforms have been only partially effective, with patronage practices persisting within a formally meritocratic institutional framework.