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

  • Joseph Antoine Nasr

    Student thesis: Doctoral Thesis


    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
    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
    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
    Date of AwardSept 2017
    Original languageEnglish
    Awarding Institution
    • University of Brighton
    SupervisorPhil Haynes (Supervisor)

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