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Public hospitals have long been major players in the US health care delivery system. However, many public hospitals have privatized during the past few decades. The purpose of this chapter was to investigate the impact of public hospitals' privatization on community orientation (CO). This longitudinal study used a national sample of nonfederal acute-care public hospitals (1997–2010). Negative binomial regression models with hospital-level and year fixed effects were used to estimate the relationships. Our findings suggested that privatization was associated with a 14% increase in the number of CO activities, on average, compared with the number of CO activities prior to privatization. Public hospitals privatizing to for-profit status exhibited a 29% increase in the number of CO activities, relative to an insignificant 9% increase for public hospitals privatizing to not-for-profit status.

Change in ownership among U.S. community hospitals has been frequent and, not surprisingly, remains an important issue for both researchers and public policy makers. In the past, investor-owned hospitals were long suspected of pursuing financial over other goals, culminating in several reviews that found few differences between for-profit and nonprofit forms (Gray, 1986; Sloan, 2000; Sloan, Picone, Taylor, & Chou, 2001). Nevertheless, continuing to the present day, several states prohibit investor-ownership of community hospitals. Conversions to investor-ownership are only one of six types of ownership change, however, with relatively less attention paid to the other types (e.g., for-profit to nonprofit, public to nonprofit). This study has two parts. We first review the literature on the various types of ownership conversion among community hospitals. This review includes the rate at which conversions occur over time, the relative frequency in conversions between specific ownership categories and the observed effects of conversion on hospital operations (e.g., strategic direction and decision-making processes) and performance (e.g., access, quality, and cost). Overall, we find that the impact of ownership conversion on the different measures is mixed, with slightly greater evidence for positive effects on hospital efficiency. As one explanation for these findings, we suggest that the impact of ownership conversion on hospital performance may be mediated by changes in the hospital's strategic content and process. Such a hypothesis has not been proposed or examined in the literature. To address this gap, we next study the role of strategic reorientation following hospital conversion in a field study. We conceptualize ownership conversion within a strategic adaptation framework, and then analyze the changes in strategy content and process across sixteen hospitals that have undergone ownership conversions from nonprofit to for-profit, public to for-profit, public to nonprofit, and for-profit to nonprofit. The field study findings delineate the strategic paths and processes implemented by new owners post-conversion. We find remarkable similarity in the content of strategies undertaken but differences in the process of strategic decision making associated with different types of ownership changes. We also find three main performance effects: hospitals change ownership for financial reasons, experience increases in revenues and capital investment post-conversion, and pursue labor force reductions post-conversion. Membership in a multi-hospital system, however, may be a major determinant of both strategy content and decision-making process that is confounded with ownership change. That is, ownership conversion may mask the impact of system membership on a hospital's strategic actions. These findings may explain the pattern of performance effects observed in the literature on ownership conversions.

Health Information Exchange (HIE) is essential for the efficient and cost-effective delivery of health-care services. The provider’s administrative structure and external environment can substantially influence adopting technologies involving inter-organizational linkages, such as HIE. Using the theoretical lens of institutional theory, this study aims to compare how public and private hospitals' engagement in HIE is influenced by corruption and government online services or e-government usage.

The study uses the positivist research design of secondary data analysis to test the six hypotheses proposed. Data from multiple third-party reliable sources, including the European Commission and World Bank, are combined into the final dataset consisting of observations from 1,442 hospitals across 30 countries in Europe. A multilevel modeling approach is used to associate country and hospital-level variables and test the hypothesis.

The study finds that, on average, a 10% increase in corruption leads to a 6.3% decrease, while a 10% increase in e-government leads to a 7% increase in the probability of HIE engagement for a hospital. The negative impact of corruption on average is 18% more in public than private hospitals, while the positive impact of e-government is 75% stronger in public in comparison to private hospitals. The study also finds that HIE engagements in health systems with predominantly public hospitals are more sensitive to corruption and e-government.

To the best of the authors’ knowledge, the study is one of the first to use the institutional view to test the influence of government actions and public providers' concentration on HIE engagement. The comparison of public and private institutions enriches our understanding of promoters and inhibitors of HIE.

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide evidence-based guidance to countries that are reforming their public hospital governance structures in line with best practice.

The paper uses the structural dimension of Cooper, Fusarelli and Randall’s policy model and institutional theory to review the legislative frameworks of four model countries supported by extant literature.

The paper conceptually distinguishes health system governance and organisational governance in the health system. It further visualises the emerging alternative legislative models of organisational governance and a hierarchy of governors applicable to public hospitals.

The paper provides critical knowledge for understanding organisational governance within health system governance framework and develops tools that can be used in reforming institutional mechanism of organisational governance of public hospitals.

The purpose of this paper is to investigate patients’ views toward the perceived service quality of public and private healthcare service providers. Determinants of healthcare service quality were compared by carrying out a GAP analysis to equate perceived and expected services and examined differences in the service quality.

The study sample comprises 310 inpatients of public and private healthcare service providers. Self-administered questionnaires were used along a five-point Likert scale and analyzed through the Statistical Package for Social Sciences. GAP analysis was used to observe the difference between expectations and perceived service quality.

A cross-sectional study revealed significant quality gaps between the expected and perceived services of public and private healthcare service providers; conversely patients’ expectations are not fully met in both types of hospitals. Private hospitals surpassed in terms of overall perceived service quality from their counterparts. Perceived services were found better in terms of physician medical services in public sector hospitals, while rooms and housekeeping services were found better in terms of private sector hospitals.

The result can be used by both public and private healthcare service providers to restructure their quality management practices which could only be possible through effective management commitment, regular patients’ feedback and translucent complaint procedures.

The study conceptualizes the expected and perceived hospital service quality dimensions as an eight-dimensional framework. A comparison between public and private sector hospitals is made to get a better understanding about the differences in the perceived healthcare services among two sectors. Consequences of the study will aid hospital managers and policy makers to get a fuller picture of healthcare services in order to contrive enhancement practices.

Using the example of capital charging in UK hospitals, this paper shows how new public policy initiatives are justified through forms of persuasion without numbers and can be challenged with empirics. A reading of official and academic texts shows how the official problem definition focuses on poor asset utilisation. Hospital accounts are then reworked to show that, although poor asset utilisation was never a major problem, the introduction of capital charges could disrupt service provision. The conclusion is that the operation of NHS hospitals should be understood in terms of distributive conflict, rather than inefficiency. Through practical demonstration, the authors of this article aim to encourage accounting researchers to use numbers to challenge public policy definitions.

The purpose of this paper is to develop a scale for measuring perceived service quality for public hospitals from the user's (patient's) perspective. The objective is to measure perceived service quality of public hospitals.

Standard scale development research procedure recommended by experts was followed. First, literature review of studies to measure service quality was undertaken. Later, Delphi method (two iterations) was used. Interviews were conducted of experts and customers for understanding and generating items for perceived service quality for public hospitals. A survey was then undertaken first for development of the scale and later for validation purpose.

A reliable and valid scale called public hospital service quality (PubHosQual) is developed to measure the five dimensions of hospital service quality: admission, medical service, overall service, discharge process, and social responsibility.

Since, this study was conducted in India only, the generalizability of the PubHosQual scale has to be tested in other countries.

The proposed scale PubHosQual in this study could be used as a diagnostic tool to identity areas where specific improvements are needed, and to pinpoint aspects of the hospital's services that require modification. The paper is an attempt to develop an instrument to incorporate the “voice of the customer.”

Most relevant studies about perceived service quality for public hospitals either do not have stable factor structure or are relying on generic SERVQUAL scale to measure service quality. The new scale fills the gap of absence of a validated scale to measure perceived service quality for public hospitals.

The purpose of this paper is to present evidence to the heated debate “whether Public-Private Partnership (PPP) model should be introduced into the hospitals” and, if so, how to promote the social sustainability of such PPP projects.

This paper has established an analytical framework to analyse the social sustainability of PPP projects. Using content analysis method, a single case study was carried out on the Northern Beaches Hospital in Sydney, Australia.

The results show that there are many problems related to social sustainability in the project, due to which employees and patients were exposed to most of them. Some recommendations are provided, including to strengthen the supervision of the project, provide sufficient information, establish communication channels and stakeholder participation, improve hospital policies and procedures, and strengthen government support.

This paper can provide guidance for the stakeholders in a partnership, including the public and private sectors, to analyse the social sustainability implications, and then plan and implement hospital PPP projects to achieve social sustainability goals. Meanwhile, it can also provide important reference for the employees, patients, local community and society to assess social sustainability issues, and provide relevant inputs to inform decision-makers in the development, delivery and management of hospital projects.

The research will contribute to knowledge of social sustainability of hospital PPP projects. The proposed analytical framework can be used to analyse and assess the social sustainability of such projects from the perspective of stakeholders.

The purpose of this paper is to examine the logic and differentiators of organizational positioning and planning of sustainability initiatives between private and public organizations in the healthcare industry. Sustainability initiatives refer to organizations’ economic, social and environmental actions.

This study is based on an inductive approach judgmental sampling and in-depth interviews of executives at private and public hospitals in Spain have been used. Data were collected from the directors of communication at private hospitals, and from the executive in charge of corporate social responsibility in public hospitals. An empirical discourse analysis is used.

The positioning and planning of sustainability initiatives differs between private and public hospitals. The former consider sustainability as an option that is required mainly for social reasons, a bottom-up positioning and planning. It emerges merely spontaneously within the organization, while the sustainability initiatives in public hospitals are compulsory. They are imposed by the healthcare system within which the public hospital, operates and constitutes a top-down positioning and planning that is structured to accomplish set sustainability goals.

A limitation of this study is that it is undertaken exclusively in Spanish organizations from one industry. This study differs from previous ones in terms of exploring the positioning and planning of the sustainability initiatives, which focus on the organizational logic of such sustainability initiatives. There are both common denominators and differentiators between private and public hospitals.

The logic of determining the positioning and planning of the sustainability initiatives is mainly about satisfying organizational needs and societal demands. Nowadays, organizations tend to engage in sustainability initiatives, so it is essential to understand the logic of how organizations position and plan such efforts.

This study investigates the path that follows sustainability initiatives in public and private organizations. It reports mainly differentiators between private and public organizations. It also contributes to explaining the organizational reasoning as to why companies make decisions about sustainability initiatives, an issue which has not been addressed sufficiently in existing theory studies.