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Sound corporate governance is now a mainstream issue of concern in the business world. However, there has been no systematic investigation of corporate governance practices in the healthcare sector. Allowing for a distinction between two types of healthcare organizations (profit and non‐profit), this paper aims to investigate nuances in the application of sound governance principles across different types of healthcare organizations in the context of a developing country, together with differing understanding and applications of corporate social responsibility.

The paper is based on a qualitative interpretive methodology, comprising in‐depth interviews with top hospital executives drawn from 21 Lebanese hospitals representing both the profit and non‐profit varieties.

The findings suggest some basic governance differences between for‐profit and non‐profit hospitals in terms of managerial structure, ownership and the role of the board of directors, as well as differing orientations towards corporate social responsibility. There is a general lack of understanding and application of corporate governance best practices in family‐owned, for‐profit hospitals, whereas non‐profit hospitals are more in line with corporate governance best practices, and more attuned to corporate social responsibility.

This paper presents fresh insights into applications of corporate governance and corporate social responsibility principles in a very important sector that has not received systematic attention and consideration in the literature.

Hospitals are complex organisations accounting for most of total health expenditure. They play a critical role in providing care to patients with high levels of need. A key policy concern is that patients receive high quality care. Policymakers have attempted to influence hospital quality in different ways. This chapter focuses on three key policy levers: the extent to which hospital competition and higher hospital tariffs (of the DRG type) can stimulate quality, and whether non-profit hospitals provide higher or lower quality than for-profit ones. The chapter outlines key methodological challenges and selectively reviews the main findings from the literature. While several studies suggest that hospital competition reduces mortality rates for heart attack cases when hospital tariffs are fixed (under a DRG system), at this stage is unclear whether the effect holds across a range of quality indicators. Moreover, the limited literature on hospital mergers tends to suggest that hospital quality does not change following a merger. Finally, whether non-profit hospitals provide higher or lower quality varies across regions and institutional arrangements. The economic theory suggests several mechanisms with opposite effects on quality. To guide policy, future work needs to further unpack the various mechanisms through which these three key policy issues affect hospitals incentives.

The objective of this paper is to address the question of whether the Balanced Scorecard (BSC) can be utilized in non‐profit organizations, in particular hospital sector organizations. A secondary objective addresses the issue of whether the BSC can be utilized employing the methodology encountered in the literature.

A case is presented of a private Spanish hospital, specializing in psychiatric patients, which is owned by a religious congregation and which utilizes a very primitive and informal information system. The case describes the design of the strategic map and the BSC for this hospital.

The paper concludes that the BSC is applicable to any type of organization, albeit with modifications; a BSC for non‐profit organizations must be modified to include a mission perspective, thus supporting Kaplan's model for non‐profit organizations. Hospitals should also include an additional perspective which provides specific information on social demographic factors regarding the hospital's operating environment.

The contribution of this paper is threefold. First, the case supports Kaplan's inclusion of a mission perspective for non‐profit organizations. Second, it further modifies the non‐profit BSC by including an additional perspective which provides specific information on social demographic factors regarding the hospital's operating environment. The authors are unaware of any instance where this additional perspective has been included in the model. Finally, the case provides a fully developed BSC and strategy map for a hospital which can be used as a template for other health‐care organizations.

The new realities of the healthcare marketplace are forcing healthcare decision makers to implement innovative operational philosophies, techniques, and tools that were proven in other industries to enhance the effectiveness of their organization. This study examines the acceptance and effectiveness of these philosophies, techniques, and tools in a hospital operational setting. The impact of implementation on operational and strategic outcomes is examined for 108 hospitals. Overall, the results of this study appear to indicate that certain quality improvement philosophies, techniques, and tools have been successful when applied in a hospital operational setting.

This chapter investigates whether signing more hospital contracts with Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), hospital affiliation in a system, having more system hospital members located in the same area, and increased competition from area hospitals, contributes to improvements in the cost efficiency of U.S. Midwestern hospitals. Hospitals may offer HMOs and PPOs discounts on contracts to provide health care services to firm employees enrolled in HMOs and PPOs (discounts would lead to smaller price mark-ups over costs for hospital services). Enacting policies to enhance cost efficiency may help hospitals maintain a specified level of profits.

New ownership types in health care of welfare states raise concerns regarding psychosocial work conditions including different control dimensions. The purpose of this paper is to investigate how job demands, control over work and control within work (CWW) were related to job satisfaction in publicly administered, private non-profit and private for-profit hospitals.

Questionnaire data came from employees at three hospitals; a publicly administered (n=774), a private non-profit (n=1,481) and a private for-profit (n=694) hospital. Mean-level analyses and hierarchical regressions with multiple group tests were conducted.

Demands including workload were significantly lower at the publicly administered hospital while the control dimension CWW was significantly higher. Background factors and their associations with job satisfaction differed slightly between ownership types. Attitudes to privatization were not associated with job satisfaction within any ownership type. Overall, psychosocial work characteristics, including job demands and control, were significantly associated with job satisfaction while their interactions showed no consistent associations with job satisfaction. As for the strength of the associations, no consistent differences emerged between ownership types.

Using self-reports only, the associations between psychosocial work characteristics and job satisfaction seemed comparable across ownership types.

Associations between psychosocial work characteristics and job satisfaction seem comparable across ownership types. This may relate to societal demands on the structuring of costs, work and production efficiency being similar for all.

Contributions include researching different occupations and their attitudes to privatization and two control dimensions considered important for different ownership types.

During the 1980s, hospital merger activity was growing steadily due to fundamental changes in the provision of health care. Recently, however, the US Government has escalated its anti‐trust scrutiny of hospital mergers. Provides an indepth analysis of two recent hospital mergers, one of which was successful and the other was not. Any hospital considering a merger can benefit from analysing the strategies that were used to combat the anti‐trust challenge in both cases.

The purpose of this paper is to give an overview of the use of strategic management accounting (SMA) techniques in hospitals under competitive market environments. The paper analyses the dissemination of SMA techniques in consideration of structural characteristics and perform a cluster analysis in order to investigate performance differences between various groups of hospitals.

The paper collected empirical data in a nationwide survey of German general hospitals. Analyses are based on questionnaires from 116 hospitals.

Results show that strategies are applied and regularly adjusted in most hospitals. However, SMA techniques are not in widespread use. The paper explores performance differences between the clusters comprised. The paper finds evidence that the use of SMA techniques varies among hospitals based on their structural characteristics.

The authors' exploratory analysis suggest that further study exploring both the determinants and effects of the use of SMA techniques in hospitals represents an interesting path for future research. This study is subject to limitations, particularly concerning the limited number of contextual variables and performance measures taken into consideration.

Considering the limited use of SMA techniques, this paper conclude that hospitals should consider the adoption of additional practices. The paper identifies particular potential for development in the areas of risk management and capital budgeting methods.

This study provides the first comprehensive overview of SMA techniques used in hospitals and advances the literature, which primarily includes case study evidence on single SMA techniques or analyses of the impact of strategies and health reforms on “conventional” management accounting practices. This paper, then, constitutes a useful starting point for further research on SMA practices in hospitals.

This chapter reviews and integrates the empirical literature on the influence of organizational factors on hospital financial performance. Five categories of organizational characteristics that research has addressed are identified and examined as part of the review: ownership, governance, integration, management strategy, and quality. With some exceptions, our review reveals a general lack of consistency and conclusiveness across studies in each area. Exceptions were found in the areas of governance (e.g., physician participation and board processes) and integration (e.g., horizontal system centralization). Despite the lack of conclusive findings across studies, our review suggests substantial opportunities for future work, including opportunities for qualitative and exploratory work. Additional implications for theory and management are discussed.

There were 4,919 registered, short-term, community hospitals in the 2004 American Hospital Association (AHA) Annual Survey of Hospitals; 60 percent of those hospitals were non-profit (NP), 23 percent of them were public (non-federal government owned and operated), and 17 percent were for-profit (FP). In general, while the absolute number of hospitals in the United States has decreased in recent years, the share of hospitals that are FP has increased. For example, in 1997, the AHA reported 5,057 registered, short-term, community hospitals, of which 59 percent were NP, 25 percent were public, and 16 percent were FP.