Yassmine Mourajid: Laboratory of Health Sciences and Technology, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco.
Mohamed Chahboune: Laboratory of Health Sciences and Technology, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco.
Abdelhadi Ifleh: Laboratory of Health Sciences and Technology, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco.
Nadia Al Wachami: Laboratory of Health Sciences and Technology, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco.
Maryem Arraji: Laboratory of Health Sciences and Technology, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco.
Karima Boumendil: Laboratory of Health Sciences and Technology, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco.
Younes Iderdar: Laboratory of Health Sciences and Technology, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco.
Fatime Zahra Bouchachi: Laboratory of Health Sciences and Technology, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco.
Abderraouf Hilali: Faculty of Science and Technology Settat, Hassan 1st University, Settat, Morocco.
PURPOSE: This paper aims to contribute to the existing literature in the field of hospital governance by exploring the relationship between the attributes and performance of hospital boards and hospital performance in terms of quality of healthcare. DESIGN/METHODOLOGY/APPROACH: A survey of board performance in public hospitals in Morocco was carried out, in which we surveyed all board members of the 13 hospitals in the Casablanca-Settat region. A total of 82 members responded (82% response rate) to the previously adapted and validated self-evaluation questionnaire on board self-assessment questionnaire (BSAQ) board member performance. FINDINGS: On average, the hospital boards studied had eight members. In terms of clinical expertise, half the members were physicians and 17% were nurses. In addition, positive correlations were found between certain board characteristics, notably age, seniority, members' perceptions of their impact on the quality of healthcare and several dimensions of board performance. In parallel, the results showed strong and significant associations between turnover rate and BSAQ score. Negative correlations were also found between average length of stay and BSAQ score. With regard to mortality parameters, it should be noted that we were unable to establish a strong empirical correlation between hospital boards' self-assessed performance and other hospital mortality indicators. RESEARCH LIMITATIONS/IMPLICATIONS: The present study offers a rigorous rationale for the use of the French-translated BSAQ in the hospital context, and we hope that others will use this tool in future work within the framework of evidence-based research. In addition, the BSAQ tool's focus on board competencies (and not just structure, composition or processes) provides valuable insights into what boards need to learn in order to function effectively. However, despite the insistence of the authors of this study on the need for a comprehensive census of public hospital board members in the region, several obstacles were encountered. Firstly, there were difficulties related to vacancies within the hospitals, which had the effect of restricting the representativeness of the sample. Secondly, access to hospital board members proved complex due to their busy schedules and the confidential nature of their meetings. Finally, it is important to note that national performance indicators in Morocco may not be as reliable as in other countries, which could complicate the identification of high-performing hospital systems and, consequently, make inference difficult. ORIGINALITY/VALUE: This study provides large-scale empirical evidence of processes related to the governance of quality of healthcare and elucidates the existence of an association between hospital board performance and clinical performance. The use of validated tools such as the BSAQ should therefore help improve the performance of boards and governance in public hospitals.
Abor, P.A. (2016), ���Healthcare governance and patients' perception of service quality in Ghana���, International Journal of Healthcare Technology and Management, Vol. 15 No. 3, p. 228, doi: 10.1504/IJHTM.2016.078367.
Ahmed, W., Bekheit, M., Eldomiaty, T. and Nagdy, H. (2021), ���Effect of hospital board governance practices on patient safety outcome���, Journal of the Medical Research Institute, Vol. 42 No. 1, pp. 9-17, doi: 10.21608/jmalexu.2021.191790.
Alexander, J.A., Weiner, B.J. and Bogue, R.J. (2001), ���Changes in the structure, composition, and activity of hospital governing boards, 1989-1997: evidence from two national surveys���, The Milbank Quarterly, Vol. 79 No. 2, pp. 253-279, doi: 10.1111/1468-0009.00205.
Ayuso, S., Rodr��guez, M.A., Garc��a-Castro, R. and Ari��o, M.A. (2014), ���Maximizing stakeholders' interests: an empirical analysis of the stakeholder approach to corporate governance���, Business and Society, Vol. 53 No. 3, pp. 414-439, doi: 10.1177/0007650311433122.
Beaton, D.E., Bombardier, C., Guillemin, F. and Ferraz, M.B. (2000), ���Guidelines for the process of cross-cultural adaptation of self-report measures���, Spine, Vol. 25 No. 24, pp. 3186-3191, doi: 10.1097/00007632-200012150-00014.
Bismark, M.M. and Studdert, D.M. (2014), ���Governance of quality of care: a qualitative study of health service boards in Victoria, Australia���, BMJ Quality and Safety, Vol. 23 No. 6, pp. 474-482, doi: 10.1136/bmjqs-2013-002193.
Botje, D., Ten Asbroek, G., Plochg, T., Anema, H., Kringos, D.S., Fischer, C., Wagner, C. and Klazinga, N.S. (2016), ���Are performance indicators used for hospital quality management: a qualitative interview study amongst health professionals and quality managers in The Netherlands���, BMC Health Services Research, Vol. 16 No. 1, p. 574, doi: 10.1186/s12913-016-1826-3.
Bradshaw, P., Murray, V. and Wolpin, J. (2012), ���Do nonprofit boards make a difference? An exploration of the relationships among board structure, process, and effectiveness���, Nonprofit and Voluntary Sector Quarterly, Vol. 21 No. 3, pp. 227-249, doi: 10.1177/089976409202100304.
Brown, W. (2005), ���Exploring the association between board and organizational performance���, Nonprofit Management and Leadership, Vol. 15 No. 3, pp. 317-339, doi: 10.1002/nml.71.
Brown, A. (2019), ���Understanding corporate governance of healthcare quality: a comparative case study of eight Australian public hospitals���, BMC Health Services Research, Vol. 19 No. 1, pp. 1-14, doi: 10.1186/s12913-019-4593-0.
Brown, A., Dickinson, H. and Kelaher, M. (2018), ���Governing the quality and safety of healthcare: a conceptual framework���, Social Science and Medicine, Vol. 202, pp. 99-107, doi: 10.1016/j.socscimed.2018.02.020.
Chait, R.P., Chait, R., Holland, T.P. and Taylor, B.E. (1993), The Effective Board of Trustees, R&L education.
Chambers, N., Harvey, G., Mannion, R., Bond, J. and Marshall, J. (2016), ���Towards a framework for enhancing the performance of NHS boards: a synthesis of the evidence about board governance, board effectiveness and board development���, Health Services and Delivery Research, Vol. 1 No. 6, pp. 1-138, doi: 10.3310/hsdr01060.
Cook, J.V., Dickinson, H.O. and Eccles, M.P. (2009), ���Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study���, BMC Health Services Research, Vol. 9 No. 1, p. 160, doi: 10.1186/1472-6963-9-160.
De Geyndt, W. (2017), ���Does autonomy for public hospitals in developing countries increase performance? Evidence-based case studies���, Social Science and Medicine, Vol. 179, pp. 74-80, doi: 10.1016/j.socscimed.2017.02.038.
De Pourcq, K., De Regge, M., Van den Heede, K., Van de Voorde, C., Paul, G. and Eeckloo, K. (2019), ���The role of governance in different types of interhospital collaborations: a systematic review���, Health Policy, Vol. 123 No. 5, pp. 472-479, doi: 10.1016/j.healthpol.2019.02.010.
De Regge, M. and Eeckloo, K. (2020), ���Balancing hospital governance: a systematic review of 15 years of empirical research���, Social Science and Medicine, Vol. 262, 113252, doi: 10.1016/j.socscimed.2020.113252.
Denis, D.K. (2001), ���Twenty-five years of corporate governance research, and counting���, Review of Financial Economics, Vol. 10 No. 3, pp. 191-212, doi: 10.1016/S1058-3300(01)00037-4.
Donaldson, L. and Davis, J.H. (1991), ���Stewardship theory or agency theory: CEO governance and shareholder returns���, Australian Journal of Management, Vol. 16 No. 1, pp. 49-64, SAGE Publications Ltd, doi: 10.1177/031289629101600103.
Emslie, S.V. (2007), Exploring the Factors that Measure the Performance of Boards of Directors of Nhs Foundation Trusts and the Association between Board and Organisational Performance, University of London.
Emslie, S. (2019), ���Exploring the factors that measure the performance of boards of directors of nhs foundation trusts and the association between board and organisational performance���.
Erwin, C.O., Landry, A.Y., Livingston, A.C. and Dias, A. (2019), ���Effective governance and hospital boards revisited: reflections on 25 Years of research���, Medical Care Research and Review, Vol. 76 No. 2, pp. 131-166, doi: 10.1177/1077558718754898.
Fabrigar, L., Wegener, D., MacCallum, R. and Strahan, E. (1999), ���Evaluating the use of exploratory factor analysis in psychological research���, Psychological Methods, Vol. 4 No. 3, pp. 272-299, doi: 10.1037//1082-989X.4.3.272.
Fama, E.F. and Jensen, M.C. (1983), ���Separation of ownership and control���, The Journal of Law and Economics, Vol. 26 No. 2, pp. 301-325, doi: 10.1086/467037.
Freeman, T., Millar, R., Mannion, R. and Davies, H. (2016), ���Enacting corporate governance of healthcare safety and quality: a dramaturgy of hospital boards in England���, Sociology of Health and Illness, Vol. 38 No. 2, pp. 233-251, doi: 10.1111/1467-9566.12309.
Furr, R. (2011), ���Scale construction and psychometrics for social and personality psychology���, doi: 10.4135/9781446287866.
Green, J.C. and Griesinger, D.W. (1996), ���Board performance and organizational effectiveness in nonprofit social services organizations���, Nonprofit Management and Leadership, Vol. 6 No. 4, pp. 381-402, doi: 10.1002/nml.4130060407.
Guillemin, F., Bombardier, C. and Beaton, D. (1993), ���Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines���, Journal of Clinical Epidemiology, Vol. 46 No. 12, pp. 1417-1432, doi: 10.1016/0895-4356(93)90142-N.
Hillman, A.J. and Dalziel, T. (2003), ���Boards of directors and firm performance: integrating agency and resource dependence perspectives���, Academy of Management Review, Vol. 28 No. 3, pp. 383-396, doi: 10.2307/30040728.
Hinkin, T.R. (1998), ���A brief tutorial on the development of measures for use in survey questionnaires���, Organizational research methods, doi: 10.1177/109442819800100106.
Holland, T.P. (1991), ���Self-assessment by nonprofit boards���, Nonprofit Management and Leadership, Vol. 2 No. 1, pp. 25-36, doi: 10.1002/nml.4130020106.
Jackson, D.K. and Holland, T.P. (1998), ���Measuring the effectiveness of nonprofit boards���, Nonprofit and Voluntary Sector Quarterly, Vol. 27 No. 2, pp. 159-182, doi: 10.1177/0899764098272004.
Jha, A. and Epstein, A. (2010), ���Hospital governance and the quality of care���, Health Affairs (Project Hope), Vol. 29 No. 1, pp. 182-187, doi: 10.1377/hlthaff.2009.0297.
Jha, A.K. and Epstein, A.M. (2012), ���Governance around quality of care at hospitals that disproportionately care for black patients���, Journal of General Internal Medicine, Vol. 27 No. 3, pp. 297-303, doi: 10.1007/s11606-011-1880-9.
Jha, A.K. and Epstein, A.M. (2013), ���A survey of board chairs of English hospitals shows greater attention to quality of care than among their US counterparts���, Health Affairs (Project Hope), Vol. 32 No. 4, pp. 677-685, doi: 10.1377/hlthaff.2012.1060.
Jiang, J.H., Lockee, C., Bass, K. and Fraser, I. (2008), ���Board engagement in quality: findings of a survey of hospital and system leaders���, Journal of Healthcare Management, Vol. 53 No. 2, pp. 121-134, doi: 10.1097/00115514-200803000-00009.
Jiang, H.J., Lockee, C. and Fraser, I. (2012), ���Enhancing board oversight on quality of hospital care: an agency theory perspective���, Health Care Management Review, Vol. 37 No. 2, pp. 144-153, doi: 10.1097/HMR.0b013e3182224237.
Jones, S.R. (2017), ���Is social innovation financing through social impact bonds the last hope for community economic development programs during the trump administration?���, Journal of Affordable Housing and Community Development Law, Vol. 26 No. 2, pp. 351-390.
Lee, R., Baeza, J.I. and Fulop, N.J. (2018), ���The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England���, BMJ Quality and Safety, Vol. 27 No. 2, pp. 103-109, doi: 10.1136/bmjqs-2016-006312.
Leggat, S. and Balding, C. (2019a), ���The impact of leadership churn on quality management in Australian hospitals���, Journal of Health, Organisation and Management, Vol. 33 Nos 7/8, pp. 809-820, doi: 10.1108/JHOM-08-2018-0216.
Leggat, S.G. and Balding, C. (2019b), ���Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care���, Australian Health Review: A Publication of the Australian Hospital Association, Vol. 43 No. 2, pp. 126-132, doi: 10.1071/AH17042.
Mannion, R. and Smith, J. (2018), ���Hospital culture and clinical performance: where next?���, BMJ Quality and Safety, Vol. 27 No. 3, pp. 179-181, doi: 10.1136/bmjqs-2017-007668.
Mannion, R., Davies, H., Freeman, T., Millar, R., Jacobs, R. and Kasteridis, P. (2015), ���Overseeing oversight: governance of quality and safety by hospital boards in the English NHS���, Journal of Health Services Research and Policy, Vol. 20 No. 1 Suppl, pp. 9-16, doi: 10.1177/1355819614558471.
Mannion, R., Davies, H.T.O., Jacobs, R., Kasteridis, P., Millar, R. and Freeman, T. (2017), ���Do Hospital Boards matter for better, safer, patient care?���, Social Science and Medicine, Vol. 177, pp. 278-287, doi: 10.1016/j.socscimed.2017.01.045.
Mcdonagh, K. (2006), ���Hospital governing boards: a study of their effectiveness in relation to organizational performance���, Journal of Healthcare Management/American College of Healthcare Executives, Vol. 51 No. 6, pp. 377-389, discussion 390, doi: 10.1097/00115514-200611000-00007.
Millar, R., Mannion, R., Freeman, T. and Davies, H.T.O. (2013), ���Hospital board oversight of quality and patient safety: a narrative review and synthesis of recent empirical research���, The Milbank Quarterly, Vol. 91 No. 4, pp. 738-770, doi: 10.1111/1468-0009.12032.
Mourajid, Y., Ghafili, A., Chahboune, M., Hilali, A. and Fihri Fassi, C. (2023), ���Governance in Moroccan public hospitals: critical analysis and perspectives for action���, International Journal of Health Governance, Vol. 28 No. 1, pp. 31-45, doi: 10.1108/IJHG-04-2022-0043.
Observatoire R��gional de Sant��, Casa-Settat (2021), ���Health in figures casablanca-settat region���.
Pfaff, H., Hammer, A., Ballester, M., Schubin, K., Swora, M. and Sunol, R. (2021), ���Social determinants of the impact of hospital management boards on quality management: a study of 109 European hospitals using a parsonian approach���, BMC Health Services Research, Vol. 21 No. 1, p. 70, doi: 10.1186/s12913-020-06053-0.
Prybil, L.D. (2016), ���Size, composition, and culture of high-performing hospital boards | Kopernio���, available at: https://kopernio.com/viewer?doi=10.1177/1062860606289628&token=WzQzMzIwNCwiMTAuMTE3Ny8xMDYyODYwNjA2Mjg5NjI4Il0.iaigVRavnHChBYzitT_CjWjv_nw (accessed 19 October 2019).
Prybil, B., B., Fardo, F. and Fardo, D.W. (2014), ���Board oversight of patient care quality in large nonprofit health systems���, American Journal of Medical Quality: The Official Journal of the American College of Medical Quality, Vol. 29 No. 1, pp. 39-43, doi: 10.1177/1062860613485407.
Rechel, B., Duran, A. and Saltman, R. (2018), ���What is the experience of decentralized hospital governance in Europe?���, in Richardson, E. and Sagan, A. (Eds), 10 Case Studies from Western Europe on Institutional and Accountability Arrangements, European Observatory on Health Systems and Policies, Copenhagen.
R��glement Int��rieur des H��pitaux (2011), ���R��glement Int��rieur des H��pitaux���.
Saltman, R.B., Dur��n, A. and Dubois, H.F.W. (Eds) (2011), Governing Public Hospitals: Reform Strategies and the Movement towards Institutional Autonomy, European Observatory on Health Systems and Policies, Belgium.
Thiel, A., Winter, V. and B��chner, V.A. (2018), ���Board characteristics, governance objectives, and hospital performance: an empirical analysis of German hospitals���, Health Care Management Review, Vol. 43 No. 4, pp. 282-292, doi: 10.1097/HMR.0000000000000153.
Triana, M., Miller, T. and Trzebiatowski, T. (2014), ���The double-edged nature of board gender diversity: diversity, firm performance, and the power of women directors as predictors of strategic change���, Organization Science, Vol. 25 No. 2, pp. 609-632, doi: 10.1287/orsc.2013.0842.
Tsai, T.C., Jha, A.K., Gawande, A.A., Huckman, R.S., Bloom, N. and Sadun, R. (2015), ���Hospital board and management practices are strongly related to hospital performance on clinical quality metrics���, Health Affairs, Vol. 34 No. 8, pp. 1304-1311, doi: 10.1377/hlthaff.2014.1282.
Van der Walt, N.T. (2001), ���The strategic board: the changing role of directors in developing and maintaining corporate capability���, Corporate Governance: An International Review, Vol. 9 No. 3, pp. 174-185, doi: 10.1111/1467-8683.00245.
van Gelderen, S.C., Zegers, M., Boeijen, W., Westert, G.P., Robben, P.B. and Wollersheim, H.C. (2017), ���Evaluation of the organisation and effectiveness of internal audits to govern patient safety in hospitals: a mixed-methods study���, BMJ Open, Vol. 7 No. 7, e015506, doi: 10.1136/bmjopen-2016-015506.
Vaughn, T., Koepke, M., Kroch, E., Lehrman, W., Sinha, S. and Levey, S. (2006), ���Engagement of leadership in quality improvement initiatives: executive quality improvement survey results���, Journal of Patient Safety, Vol. 2, pp. 2-9.
Williams, B., Brown, T., Onsman, A., Williams, A.B., Onsman, A., Brown, T., Williams, M.B., et al. (2010), ���Exploratory factor analysis: a five-step guide for novices���.
