Measuring state-owned health care organisations board performance, accounting for national culture: the case of Greece

Background and Objective: The performance of public hospitals is a concern to communities seeking to improve the health status of their citizens. Previous research provides support for the argument that at least in some ways organisational effectiveness is related to governance effectiveness, and the strengthening of the board members competencies might improve governance. There is a need for constructing valid and reliable board self-assessment survey instruments based specifically on public (state owned) hospital board competencies models that could be useful for board performance improvement. The main aim of this study is to investigate board performance and cultural issues. The ultimate aim is to develop board performance models considering public hospitals, taking into account cultural differences, suitable for improving governance.
Methodology: A questionnaire survey was conducted to gather data related to board competencies in public hospitals in Greece, and to national culture. Board competencies models were developed, and empirically tested, modified and retested using the Structural Equation Modelling (SEM) approach.
Findings: Six valid and reliable self-administered questionnaires were constructed to measure board competencies in public hospitals in Greece, taking into account national culture. The estimated non-culturally invariant board governance competencies average scores would indicate that the public hospital boards in Greece performed well in the analytical arena, were politically sensitive to the various constituencies, were strong from a strategic standpoint, and also, on the interpersonal or nurturing aspects among the board members, as well as in terms of understanding the context of the healthcare environment. There seemed to be less emphasis and less strength in the educational competence, which may indicate a need for greater board instruction and development.
Originality/value: The study is unique in that board performance models taking account of cultural issues for public hospitals have never been developed so far. The product, for practical use, of the research project is the constructed board performance self-assessment survey instruments for improvement measures, to be used for improving governance of public hospitals in Greece.