Hospital governance in Lebanon: corporate and clinical governance in non-profit private hospitals

Abstract

There are multiple internal and external governance mechanisms intended to
ensure the functioning of corporations, while maintaining the interests of
stakeholders. Although corporate governance is a growing area of research,
empirical research is restricted. This research study critically examines
historical definitions of corporate governance. It explains the relationship of
corporate and clinical governance and explores clinical governance as a
subset of hospital governance. It aids an understanding of hospital
governance through an examination of the governance of a sample of nonprofit
Lebanese hospitals. It examines the relationship of governance with
performance. It explores how managers and clinicians are incentivized and
the relationship of this to performance. It compares the governance
processes between three hospitals and examines the influence of external
factors.
Mixed methods are used, including quantitative surveys that are developed
and explored using factor analysis, and qualitative semi-structured
interviews. The findings are used to critically examine major corporate
governance theories and their relevance to understanding hospital
governance, by understanding the perspectives of those employed in the
hospitals.
Using critical realism as a theoretical framework, the findings show how the
mechanisms of hospital governance are perceived. The survey data from
207 participants were subjected to principal components analysis which
resulted in a single factor solution representing individual perceptions of
hospital governance for all respondents. The results of perceptions differed
according to differences in managerial role, management experience,
management education, leadership role, number of years working at the
hospital, current role, and the hospital studied. Differences in age and gender
had no significant effect. Findings also revealed that clear methods of
performance measurement were perceived to be in used in each of the three
hospitals, with a good knowledge of the used performance measurement.
Hospitals have a good mission, and clear structures. There is a good
knowledge of the external stakeholders to the hospitals and their roles, and the involvement of external stakeholders in hospitals is proven to be core to
their overall ability to function. The hospitals have good clinical performance
and governance systems in terms of quality and safety. On the other hand,
there are management deficits. There is an absence of monetary incentives
which was mainly caused by corporate governance events represented by a
conflict of interest case. This appeared to be caused by the minor role of the
board of directors, accompanied with the lack of adequate background,
knowledge, and education of its members, resulting in a lack of control over
the CEO. These corporate governance events were shown to change
interviewees‘ perception of hospital governance. The hospitals also had
problems with the internal reporting systems.
The contribution of this study lies in illuminating the employees‘ perspectives
of corporate governance in the hospital settings. It questions and informs
theoretical approaches to the traditional principal-agent and stakeholder
models. It creates tools for measuring clinicians‘ and managers‘ perceptions
of hospital governance where they work. It shows how corporate governance
‗events‘ affect both clinical and corporate governance. It provides evidence of
the importance of the stakeholder approach to hospital governance and
demonstrates the influence of external factors on internal hospital
governance.

Date of Award	Sept 2017
Original language	English
Awarding Institution	University of Brighton
Supervisor	Philip Haynes (Supervisor)