Gender representation and financial performance: an empirical analysis of public hospitals

• DOI: https://doi.org/10.1108/IJPSM-01-2022-0004
• Published date: 22 June 2022
• Date: 22 June 2022
• Pages: 603-621
• Subject Matter: Public policy & environmental management,Politics,Public adminstration & management
• Author: Valeria Naciti,Guido Noto,Carlo Vermiglio,Gustavo Barresi

Gender representation and

financial performance:

an empirical analysis

of public hospitals

Valeria Naciti, Guido Noto, Carlo Vermiglio and Gustavo Barresi

Department of Economics, University of Messina, Messina, Italy

Abstract

Purpose –Recently, the relationship between gender representation and organizational performance has been

the focus of various studies. However, some research gaps still exist. First, in the healthcare sector, this

relationship has been poorly explored. Moreover, in public management studies, researchers focusing on

performance tend to focus exclusively on gender differences at the top and/or middle management level. This

research aims at exploring the relationship between women’s representation and performance in public

hospitals at all organizational levels.

Design/methodology/approach –To achieve the research objective, 63 healthcare organisations were

analysed through ordinary least squares regressions on panel data from 2012 to 2018.

Findings –Results show that, in the hospital setting, gender diversity and financial performance are related at

every organizational level.

Originality/value –To the authors’knowledge, this is one of the first studies focusing on the link between

gender and performance at every level of professional and employment category; avoiding focusing

exclusively on top management, which was the case in previous studies on the topic. Moreover, it contributes to

a poorly explored literature which is gender studies in public healthcare management.

Keywords Gender, Women, Healthcare, Hospital, Performance

Paper type Research paper

1. Introduction

In the last decade, the mana gement literature has foc used increasingly on women’s

representation and its impact on or ganisational performance (Campbell and M



ınguez-Vera,

2008;Ali et al.,2011;Opstrup and Villadsen, 2015;Naciti, 2019;Naci ti et al., 2021a;Park,

2021;Galletta et al.,2022). Most of the studies have confirmed a posit ive relationship

between women’s representation and organisat ional performance (Sabhar wal, 2014;Park,

2021). This has been explained b y adopting multiple perspectives. S ome authors agree that a

greater presence of women in to p management positions allows organi sations to put in place

better decision-making pr ocesses due to the different skil ls and characteristics of the

management (Bart and McQueen, 2013;AbouAssi and An, 20 17). Others maintain that

better performance is the res ult of a lack of discrimination, w hich allows organisations to

select managers based on th eir competencies and not on their gender, rac e, religion, and so

on (Kim and Starks, 2016).

An analysis of

public

hospitals

603

© Valeria Naciti, Guido Noto, Carlo Vermiglio and Gustavo Barresi. Published by Emerald Publishing

Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone

may reproduce, distribute, translate and create derivative works of this article (for both commercial and

non-commercial purposes), subject to full attribution to the original publication and authors. The full

terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

The authors would like to thank the anonymous reviewers for the useful comments and suggestions

provided. Moreover, the authors wish to thank the participants of the 2021 IRSPM Conference who

provided valuable feedback on the first draft of this work.

The current issue and full text archive of this journal is available on Emerald Insight at:

https://www.emerald.com/insight/0951-3558.htm

Received 3 January 2022

Revised 22 March 2022

11 May 2022

Accepted 13 May 2022

International Journal of Public

Sector Management

Vol. 35 No. 5, 2022

pp. 603-621

Emerald Publishing Limited

0951-3558

DOI 10.1108/IJPSM-01-2022-0004

Though most research on gender focuses on private sector organizations, attention to the

relationship between gender representation and organizational performance has also been

devoted by public administration and management scholars (Riccucci, 2002;Linstead, 2005;

Pitts, 2005;Meier et al., 2006;Mastracci and Bowman, 2015;Opstrup and Villadsen, 2015;Kim

and Park, 2017;Park, 2013,Park, 2021;Cuadrado-Ballesteros et al., 2021). However, to the best

of the authors’knowledge, little attention has been paid to the healthcare sector (Lanz, 2008;

Miller, 2009;Ellwood and Garcia-Lacalle, 2015;Arena et al., 2021).

According to the World Health Organisation (WHO), healthcare organisations are

characterised by occupational gender segregation and inequality between men and women in

health roles and professions (Blackburn et al., 2002). It is a stratification that reflects gender

stereotypes and leads to an underestimation of the personal skills necessary to perform

particular functions with respect to the characteristics associated more generally with gender

(WHO, 2019). Horizontal segregation is particularly evident in nursing and obstetrics –where

most of the employees are women –or in surgery –where most of the employees are men.

This creates within organizations strongly unbalanced categories in which one gender could

be significantly underrepresented. Moreover, the 2020 Global Health 50/50 report (Global

Health 50/50, 2020) states that 69% of healthcare organisations are headed by men and 80%

of leadership positions are filled by men. An invisible barrier prevents women from reaching

the highest levels of the hierarchy: the so-called glass ceiling (El Arnaout et al., 2019). The

most prestigious and best-paid managerial roles are not accessible to females, so occupational

segregation by gender might also be described as vertical. Due to the above-mentioned

characteristics and the resulting complexity, healthcare organizations offer interesting

opportunities to analyse and better comprehend the relationships between women’s

representation –at each organizational level –and the organizational performance in the

public sector. As such, this study aims at contributing to the ongoing debate over gender

differences in public management focusing on the healthcare sector.

To achieve this objective, the authors collected data on the percentage of females in every

professional category for all Italian public autonomous hospitals. In addition, two financial

indicators have been computed –one aimed at measuring organisational solvency and one

aimed at measuring economic efficiency. Overall, 63 healthcare organisations were analysed

through Ordinary Least Squares (OLS) regressions on panel data from 2012 to 2018.

The study is organised as follows. The following section comprises a brief review of the

literature relating to the study’s research question. The third section describes the sample

that was analysed and the research methodology. The fourth section presents the findings.

The final section sets out conclusive assessments and discusses the implications of the study.

2. Theoretical background

2.1 Gender studies in public sector management

Gender studies are emerging in the public management debate (McDougall, 1998;Pitts and

Wise, 2010;Mastracci and Bowman, 2015;Kim and Park, 2017;Park, 2021;Cuadrado-

Ballesteros et al., 2021;Polzer et al., 2021). Most of these researches adopt the representative

bureaucracy theory according to which public organizations employing a bureaucracy that

matches the general population on salient indicators of diversity - such as race, ethnicity, or

gender - manage to develop policies better suited to the interests of diverse groups (Meier,

1993;Pitts, 2005;Park, 2013;Riccucci et al., 2014).

A recent stream of research has examined the relationship between gender and

performance at the organisational level by linking gender representation and diversity

measures to specific outcomes (Park, 2021). This relationship has been investigated in

different public settings ranging from national to local government.

Meier et al. (2006) carried out an empirical analysis of public schools in Texas and

concluded that organisations with more women in the classroom were characterised by

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