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Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Administration

First Advisor

Dr. Robert E. Hurley


Years ago it was typical for a physician to serve as a hospital's Chief Executive Officer (CEO). However, with the development of Master of Health Administration, Master of Public Health, and Master of Business Administration programs, hospitals began to move away from this model. Today however, as hospitals search for innovative ideas to reduce healthcare costs and improve the quality of care, the idea of the physician hospital CEO has returned. Little empirical research is available in the health services literature on the physician hospital CEO. The study aims to examine the relationship between organizational and environmental factors and physician CEOs, and whether or not physician CEOs are associated with improved hospital performance.The conceptual framework is adapted from Donabedian's structure, process, and outcome perspective, which when applied to the organizational level becomes context design-performance. The theoretical perspective applied to the conceptual framework to guide the development of hypotheses is contingency theory, which suggests that organizations are most successful when they can adapt their structures to fit their environment.Data for this study were obtained from multiple sources: American Hospital Association Annual Survey, the Centers for Medicare and Medicaid Services Hospital Cost Reports, SK&A, Area Resource File, and the Centers for Medicare and Medicaid Services Hospital Quality Alliance.Besides descriptive analyses, logistic regression was used in this study to evaluate the relationship between the organizational and environmental hospital characteristics. Ordinary least squares regression was used to explore the relationship between physician CEOs and hospital performance.Results indicate that hospitals in markets with greater physician competition are more likely to have physician CEOs. Hospitals that are affiliated with a system are also more likely to have physician CEOs. The study found that while teaching hospitals and specialty hospitals were associated with placement of physician CEOs, it was in the opposite direction of what was hypothesized. This may be a result of the small sample size of both teaching and specialty hospitals in the study sample. The study concludedthat having a physician CEOs is associated with hospital financial outcomes but not associated with its quality of care outcomes.


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Date of Submission

June 2008