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" Hospital governance in Lebanon : "
Nasr, Joseph Antoine
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Latin Dissertation
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| Record Number
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833122
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TLets754006
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| Main Entry
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Nasr, Joseph Antoine
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| Title & Author
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Hospital governance in Lebanon :\ Nasr, Joseph Antoine
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| College
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University of Brighton
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| Date
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2017
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| student score
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2017
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| Degree
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Thesis (Ph.D.)
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| Abstract
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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.
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University of Brighton
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