Gender Diversity in Public Hospitals' TMT: The Impact on Financial and Non-Financial Performance

Several public reforms have tried to ensure the involvement of women in hospital governance to encourage their career advancement and their representation in top management positions. However, literature suggests that women are still under-represented in global health leadership and highlights a strong gender discrimination in the healthcare sector due to the barriers that limit their career advancement. Despite the evidence shows that women are still under-represented as leaders, there are many reasons to believe that including women in the top management team (hereafter TMT) may be beneficial for hospital outcomes. Relying on various gender theories, previous corporate governance research has extensively shown that board gender diversity fosters the close monitoring of the strategic decisions, brings to the boardroom critical resources, and stimulates the debate among directors enhancing the exchange of ideas. However, limited efforts have been made with regard to the performance effects of women involvement in hospital governance. The article investigates the effect of women in TMT on hospital performance. To this aim, it examines a sample of 102 Italian public hospitals, including general, teaching and research hospitals. We collect information on hospital performance and composition of TMTs from multiple data sources (i.e. NHS databases, hospital reports, and hospital websites). We capture hospital performance with reference to both financial and non-financial outcomes. Indeed, much of the criticism of focusing only on the impact of women on financial performance stems from the idea that it may diminish prospects for overall improvement due to the complex and multifaceted purposes of healthcare organizations. Findings document that the presence of women in hospital TMT does not affect the financial performance, while it has a negative effect on non-financial dimensions. The paper has contributions for theory and practices. From a theoretical standpoint, analyzing financial and non-financial performance implications of women in hospital governance, our results contributes to the existing empirical research on women in governance by providing insight into the healthcare sector that is still under-explored. From a practical standpoint, our research suggests the importance of fostering the participation of women on TMT to bring hospital governance with values, backgrounds and skills able to improve organizational results. Thus, it calls for proper normative actions aiming to foster a higher participation of women at apical positions in hospital governance.