title: Shareholder value and the performance of a large nursing home chain.
abstract: OBJECTIVE
  To analyze corporate governance arrangements and quality and financial performance outcomes among large multi-facility nursing home corporations (chains) that pursue stakeholder value (profit maximization) strategies.
  
  
  METHODS
  To establish a foundation of knowledge about the focal phenomenon and processes, we conducted an historical (1993-2005) case study of one of the largest chains (Sun Healthcare Inc.) that triangulated qualitative and quantitative data sources.
  
  
  METHODS
  Two main sets of information were compared: (1) corporate sources including Sun's Security Exchange Commission (SEC) Form 10-K annual reports, industry financial reports, and the business press; and (2) external sources including, legal documents, press reports, and publicly available California facility cost reports and quality data.
  
  
  RESULTS
  Shareholder value was pursued at Sun through three inter-linked strategies: (1) rapid growth through debt-financed mergers; (2) labor cost constraint through low nurse staffing levels; and (3) a model of corporate governance that views sanctions for fraud and poor quality as a cost of business.
  
  
  CONCLUSIONS
  Study findings and evidence from other large nursing home chains underscore calls from the Institute of Medicine and other bodies for extended oversight of the corporate governance and performance of large nursing home chains.
authors.affiliation: Cardiff Business School, Cardiff University, Aberconway Building, Colum Drive, Cardiff CF10 3EU, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Kitchener
authors.forename: Janis
authors.initials: J
authors.lastname: O'Meara
authors.forename: Ab
authors.initials: A
authors.lastname: Brody
authors.forename: Hyang Yuol
authors.initials: HY
authors.lastname: Lee
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
mesh_terms: D017598:Efficiency, Organizational / Q000191:economics*; D005375:Financial Audit; D006801:Humans; D007449:Investments / Q000191:economics*; D009096:Multi-Institutional Systems / Q000191:economics* / Q000458:organization & administration; D009735:Nursing Homes / Q000191:economics* / Q000458:organization & administration; D019982:Organizational Case Studies; D016134:Organizational Policy