This study examines the role of top management team culture in hospitals located in Canada, the UK and the USA. Clan, developmental, empirical, and rational cultures were identified using the competing values framework. This study was organized around three basic questions. The first question asked whether hospital management teams in the USA, Canada and the UK have different management cultures given the differences in their political economies. The second question asked whether management culture was associated with differences in performance? The third question addressed the issue of the legitimacy of culture type as an independent variable. If culture type has legitimacy, other organizational variables such as structure, conflict resolution style, market strategy, and stakeholder priorities should be manifested differently in each culture type. The findings support the legitimacy of the culture variable and the premise that the political economy influences the distribution of culture types. The dominant cultures of the hospital management teams studied were positively and significantly related to organizational performance for clan, rational, and developmental cultures. The implications for management theory, professional practice and public policy are discussed.