Hospital Management and the Contribution of Non-Sector Expertise

A belief in the value and superiority of private sector management expertise has been central to NPM reforms (Ferlie et al., 1996; Hood, 1991; Pollitt & Bouckaert, 2000), leading to concerted efforts to re-structure public organisations and recruit senior managers from the commercial sector, including accountants (Clatworthy et al., 2000; Ferlie et al., 1995). It is assumed that such expertise will have a transformative impact on public organisations, moving them away from models of professionally dominated ‘custodial’ or ‘consensus administration’. Commercial managers will emphasise the importance of resources, the need to meet performance targets, and have the ability to implement changes.

However, while these assumptions and expectations lie at the heart of policy making worldwide, there is little research that has tested them directly. Some work has been done on the impact of senior leaders in local government (Boyne, 2004; Boyne et al., 2011) and school districts (Meier & O'Toole Jr, 2002; Moynihan & Pandey, 2005). As yet however, there continues to be a dearth of evidence supporting the assumption that diversifying the skill mix of senior managers in public organisations will lead to enhanced performance.

To address this deficiency, we focus on the impact of this non-sector specific commercial expertise on the boards of acute hospital trusts in the English NHS. Drawing on the governance literature focusing on the human (and social) capital of board members (Haynes & Hillman, 2010; Kor & Sundaramurthy, 2009), we first investigate whether a more diverse skill mix of senior managers makes a difference and if so, under what conditions. Given the dominance of clinical logics in the fields of health care (Reay & Hinings, 2005), we, then, look at the nature of performance outcomes and whether other factors, such as tenure and autonomy, mediate the impact of commercial and accounting expertise