This study examines an important potential conflict between the institutional, governance, and strategic functions of boards. We specifically test how higher levels of board size and diversity, traditionally associated with optimal institutional and governance performance of boards, affect the boards ability to initiate strategic changes during periods of environmental turbulence. Our findings suggest that board diversity, in particular, may be a significant constraint on strategic change.

https://www.jstor.org/stable/pdfplus/2486969.pdf

The effects of board size and diversity on strategic change

STUDY QUESTION: An examination of the effects of top management, board, and physician leadership for quality on the extent of clinical involvement in hospital CQI/TQM efforts. DATA SOURCES: A sample of 2,193 acute care community hospitals, created by merging data from a 1989 national survey on hospital governance and a 1993 national survey on hospital quality improvement efforts. STUDY DESIGN: Hypotheses were tested using Heckman's two-stage modeling approach. Four dimensions of clinical involvement in CQI/TQM were examined: physician participation in formal QI training, physician participation in QI teams, clinical departments with formally organized QA/QI project teams, and clinical conditions and procedures for which quality of care data are used by formally organized QA/QI project teams. Leadership measures included CEO involvement in CQI/TQM, board quality monitoring, board activity in quality improvement, active-staff physician involvement in governance, and physician-at-large involvement in governance. Relevant control variables were included in the analysis. PRINCIPAL FINDINGS: Measures of top management leadership for quality and board leadership for quality showed significant, positive relationships with measures of clinical involvement in CQI/TQM. Active-staff physician involvement in governance showed positive, significant relationships with clinical involvement measures, while physician-at-large involvement in governance showed significant, negative relationships. CONCLUSIONS: Study results suggest that leadership from the top promotes clinical involvement in CQI/TQM. Further, results indicate that leadership for quality in healthcare settings may issue from several sources, including managers, boards, and physician leaders.

Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership.

This study draws on the institutional and resource-based theories of the firm and examines whether multi-product firms use mergers as a strategic tool to reconfigure their product-mix toward high-profit products. We propose that mergers facilitate product-mix reconfiguration by relaxing institutional and organizational constraints on resource redeployment. Analysis of data from the U.S. hospital industry reveals that, relative to non-merging hospitals, merging hospitals increased their presence in profitable, insured services but did not shift away from low-profit services used by the uninsured. Copyright © 2004 John Wiley & Sons, Ltd.

The influence of mergers on firms' product‐mix strategies

This special issue is dedicated to the theme of change within and around the Professional and Human Service Organizations. The introduction points out the ongoing changes in the societal, economic and business environments within which the professions and professional firms are embedded. We suggest that the reality of such environmental changes brings to the fore questions that are important for the research agenda on the professions. Several such issues are raised, like the impact of advanced information technologies, processes of globalization, pressures for business mergers, privatization and more.The concem here was to explore some of the issues involved with the theme of change in professional and human services. The perspectives taken, and the different conclusions presented, initiate an interesting and important debate on macro-level and firm-level changes in the professions and the 'expert power' underlying them.

http://journals.sagepub.com/doi/pdf/10.1177/017084069601700401

Change as an Underlying Theme in Professional Service Organizations: An Introduction

As performance accountabilities, external oversight, and market competition among not-for-profit (NFP) hospitals have grown, governing boards have been given a more central leadership role. This article examines these boards' effectiveness, particularly how their configuration influenced a range of performance outcomes in NFP community hospitals. Results indicate that hospitals governed by boards using a corporate governance model, versus hospitals governed by philanthropic-style boards, were likely to be more efficient and have more admissions and a larger share of the local market. Occupancy and cash flow were generally unrelated to hospitals' governing board configuration. However, effects of governance configuration were more pronounced in freestanding and public NFP hospitals compared with system-affiliated and private NFP hospitals, respectively.

/pdf/does-governance-matter-board-configuration-and-performance-5bo4x49wid.pdf

Does governance matter? Board configuration and performance in not-for-profit hospitals.

Hospital corporate restructuring is the segmentation of assets or functions of the hospital into separate corporations. While these functions are almost always legally separated from the hospital, their impact on hospital policymaking may be far more direct. This study examines the effects of corporate restructuring by community hospitals on the structure, composition, and activity of hospital governing boards. In general, we expect that the policymaking function of the hospital will change to adapt to the multicorporate structure implemented under corporate restructuring, as well as the overlapping boards and diversified business responsibilities of the new corporate entity. Specifically, we hypothesize that the hospital board under corporate restructuring will conform more to the "corporate" model found in the business/industrial sector and less to the "philanthropic" model common to most community hospitals to date. Analysis of survey data from 1,037 hospitals undergoing corporate restructuring from 1979-1985 and a comparison group of 1,883 noncorporately restructured hospitals suggests general support for this hypothesis. Implications for health care governance and research are discussed.

B D Gifford

Papers

The effects of corporate restructuring on hospital policymaking.