title: Hospital ownership, decisions on supervisory board characteristics, and financial performance.
abstract: BACKGROUND
  Dynamic and complex transformations in the hospital market increase the relevance of good corporate governance. However, hospital performance and the characteristics of supervisory boards differ depending on ownership. The question therefore arises whether hospital owners can influence performance by addressing supervisory board characteristics.
  
  
  OBJECTIVE
  The objective of this study is to explain differences in the financial performance of hospitals with regard to ownership by studying the size and composition of supervisory boards.
  
  
  METHODS
  The AMADEUS database was used to collect information on hospital financial performance in 2009 and 2010. Business and quality reports, hospital websites, and data from health insurer were used to obtain information on hospital and board characteristics. The resulting sample consisted of 175 German hospital corporations. We utilized ANOVA and regression analysis to test a mediation hypothesis that investigated whether decisions regarding board size and composition were associated with financial performance and could explain performance differences.
  
  
  RESULTS
  Financial performance and board size and composition depend on ownership. An increase in board size and greater politician participation were negatively associated with all five tested measures of financial performance. Furthermore, an increase in physician participation was positively associated with one dimension of financial performance, whereas one negative relationship was identified for nurse and economist participation. For clerics, no associations were found.
  
  
  CONCLUSIONS
  Decisions concerning board size and composition are important as they relate to hospital financial performance. We contribute to existing research by showing that, in addition to board size and physician participation, the participation of other professionals can also influence financial performance.
authors.affiliation: Ludwig Kuntz, PhD, is Professor, Department of Business Administration and Health Care Management, University of Cologne, Germany. Jannis Pulm, MSc, is Assistant Manager, KPMG AG Wirtschaftsprüfungsgesellschaft, Cologne, Germany. Michael Wittland, PhD, is Research Associate, Department of Business Administration and Health Care Management, University of Cologne, Germany. E-mail: wittland@wiso.uni-koeln.de.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kuntz
authors.forename: Jannis
authors.initials: J
authors.lastname: Pulm
authors.forename: Michael
authors.initials: M
authors.lastname: Wittland
mesh_terms: D003659:Decision Making, Organizational; D004469:Economics, Hospital; D005377:Financial Management, Hospital / Q000191:economics / Q000458:organization & administration*; D006075:Governing Board; D010067:Ownership; D010820:Physicians