Fabrizia Sarto

Clinical leadership and hospital performance: assessing the evidence base

BackgroundA widespread assumption across health systems suggests that greater clinicians’ involvement in governance and management roles would have wider benefits for the efficiency and effectiveness of healthcare organisations. However, despite growing interest around the topic, it is still poorly understood how managers with a clinical background might specifically affect healthcare performance outcomes. The purpose of this review is, therefore, to map out and critically appraise quantitatively-oriented studies investigating this phenomenon within the acute hospital sector.MethodsThe review has focused on scientific papers published in English in international journals and conference proceedings. The articles have been extracted through a Boolean search strategy from ISI Web of Science citation and search source. No time constraints were imposed. A manual search by keywords and citation tracking was also conducted concentrating on highly ranked public sector governance and management journals. Nineteen papers were identified as a match for the research criteria and, subsequently, were classified on the basis of six items. Finally, a thematic mapping has been carried out leading to identify three main research sub-streams on the basis of the types of performance outcomes investigated.Results and contributionThe analysis of the extant literature has revealed that research focusing on clinicians’ involvement in leadership positions has explored its implications for the management of financial resources, the quality of care offered and the social performance of service providers. In general terms, the findings show a positive impact of clinical leadership on different types of outcome measures, with only a handful of studies highlighting a negative impact on financial and social performance. Therefore, this review lends support to the prevalent move across health systems towards increasing the presence of clinicians in leadership positions in healthcare organisations. Furthermore, we present an explanatory model summarising the reasons offered in the reviewed studies to justify the findings and provide suggestions for future research.

Women on board: evidence from a masculine industry

Purpose – This paper aims to provide insights on the gender-performance relationship, this paper studies the impact of board gender diversity on firm performance, by taking into account the “critical mass” of women directors and their educational level. Design/methodology/approach – The hypotheses are tested on a unique dataset of 211 European Union publicly listed companies in 2012 belonging to the construction industry from 28 different countries through a set of ordinary least squares regressions. Findings – The evidence shows that the “critical mass” rather than the simple presence of women has an incremental benefit on firm performance. In addition, results show that the educational level of women directors negatively affects firm performance, as it might impact the dynamics within the boardroom. Research limitations/implications – The quantitative nature of the study does not allow drawing strong inferences on behavioral processes and dynamics in and around the boardroom. Nevertheless, this study wi...

Exploring healthcare governance literature: systematic review and paths for future research

The paper aims to illustrate the stance of existing research on governance in healthcare organizations (hereafter HCOs), in order to appreciate the structure of literature and its evolution. More specifically, thorough a keywords analysis of 91 articles published in 1985-2010 timeframe, the article attempts to understand how setting peculiarities affect the healthcare governance field and to provide some suggestions for future research. The findings enlighten the existence of three main research streams, as well as the absence of a research evolution. The novelty of the paper relies on its contributions for academics by providing a keywords map as a useful tool to understand greatest concentration areas and vice versa never investigated issues whereon focusing future efforts.

Exploring regionalism in public management reforms: the case of the Italian hospital sector

Although comparative research on new public management reforms has identified variable pathways of change between countries, less is known about variations within countries where there has been significant political and administrative decentralisation to regional tiers of government. In this paper we address this concern, focusing on public hospital management reforms in the Italian Servizio Sanitario Nazionale (SSN) as an illustrative case. Drawing on a range of publicly available administrative data sources we find that there is a significant regional dimension, with more autonomous regional governments with centre-right political majorities being more likely to adopt corporate-style management practices at hospital level.

The Role of Women on Board for Innovation: Lessons from the High-tech Companies

Building on previous research on gender diversity in corporate governance, the article empirically examines the implications of women on board for the company commitment to innovation by focusing on the presence, the critical mass and the human capital diversity of female directors. To this purpose, it relies on a unique dataset of Italian companies belonging to the high-tech industry as this context is considered male-dominated. Findings document that female directors positively affect the company commitment to innovation only when boards are characterized by a critical mass of women. Moreover, the analyses show that the human capital diversity of female directors enhances the firm commitment to innovation. Thereby, the study offers contributions to both scholars and practitioners. Indeed, it fuels the debate on the role played by women on board and emphasizes the importance of fostering the appointment of female directors, especially as critical mass. In addition, it highlights that the critical mass of female directors can exploit the benefits of gender diversity as it limits the emerging conflicts within the boardroom as well as hampers the risk-aversion, the skill underestimation and the sense of inferiority that is typical of women on board in masculine industries. Finally, the research emphasizes the relevance of mixing the diverse educational/professional backgrounds of female directors to foster the development of new ideas and improve the cross-functional discussions among board members to the benefit of company innovation.

Balanced performance measurement in research hospitals: the participative case study of a haematology department

BackgroundThe paper aims to review, design and implement a multidimensional performance measurement system for a public research hospital in order to address the complexity of its multifaceted stakeholder requirements and its double institutional aim of care and research.MethodThe methodology relies on a participative case study performed by external researchers in close collaboration with the staff of an Italian research hospital.ResultsThe paper develops and applies a customized version of balanced scorecard based on a new set of performance measures. Our findings suggest that it can be considered an effective framework for measuring the research hospital performance, thanks to a combination of generalizable and context-specific factors.ConclusionsBy showing how the balanced scorecard framework can be customized to research hospitals, the paper is especially of interest for complex healthcare organizations that are implementing management accounting practices. The paper contributes to the body of literature on the application of the balanced scorecard in healthcare through an examination of the challenges in designing and implementing this multidimensional performance tool. This is one of the first papers that show how the balanced scorecard model can be adapted to fit the specific requirements of public research hospitals.

La valutazione aziendale delle Case di Cura private: note per la determinazione del valore dell’accreditamento

Nel corso degli ultimi anni, le occasioni di valutazione economica di asset e imprese nel settore sanitario si sono moltiplicate. Tuttavia, rimane ancora lieve l’interesse della ricerca sul tema. La valutazione delle aziende professionali in settori regolamentati si presenta alquanto complessa, specie in riferimento alle componenti intangibili. Questo articolo, da un lato, prova a richiamare l’attenzione dei ricercatori a fornire evidenze e quadri concettuali sull’argomento e, dall’altro, delinea talune note sulla determinazione del valore delle Case di Cura, terminando con una simulazione della valutazione dell’accreditamento.

Performance implications of public–private partnerships in research hospitals: Lessons from the involvement of a charity:

The paper examines the financial and non-financial performance effects of the third sector involvement in public research hospitals. By relying on multiple data sources, the study compares the performance of an Italian public research hospital before and after the establishment of a partnership with a charity institution. The results reveal that the involvement of the charity is beneficial for both care and research activities, thus supporting the research hospital in achieving its twofold mission. Beside the advancement of the literature, the paper offers a successful example of collaboration between public and not-for-profit organizations that can be replicated to improve public health.

Alignment vs rent-extraction effects of stock options. A conceptual model

Purpose This paper aims to develop a conceptual model that systematically interprets how key governance factors drive the alignment and the rent-extraction effects of executive stock options (SOs) as proxied by plan characteristics. Design/methodology/approach The authors draw on the review of 202 articles published in international academic journals. They collect data from library databases and by hand-searching and citation-tracking relevant papers on the topic. Moreover, the authors review and classify the studies as related with determinants or proxies of alignment and rent-extraction effects of SOs. Findings The conceptual model systematically interprets the results of the literature review and identifies the relationships between archetypes, driving factors and proxies of the rent/alignment effect of executive SOs. It highlights that, given ownership archetypes, effective (ineffective) governance practices drive the alignment (rent) aim of SOs as proxied by the optimal (non-optimal) plan design. Practical implications This paper supports compensation committees in selecting the SO characteristics that better attract investors and retain executives. Moreover, it guides future policy making interventions aiming at mitigating the rent-extraction effect of SOs. Originality/value The paper highlights that the governance determinants of SO aims can be effectively classified as archetypes or drivers of rent-extracting and aligning outcomes of these remuneration tools. Moreover, it offers a useful framework to guide future research efforts by providing a comprehensive interpretation of the relationships between ownership archetypes, driving factors and proxies of SO effects.