ABSTRACT HOSPITALS WITH PHYSICIAN CEOS: AN INSTITUTIONAL THEORY PERSPECTIVE By: Jeremy S. Zoch, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Health Related Sciences at Virginia Commonwealth University. Virginia Commonwealth University, 2011 Major Director: Kenneth R. White, Ph.D. Professor Department of Health Administration The complexities of the healthcare industry at the beginning of the 21st century continue to challenge hospitals to optimize their operations. A key leadership position in the overall success of a hospital is the role of the Chief Executive Officer. The purpose of this study was to determine the kind of leader that hospitals have in place and to analyze more closely those specific organizations that have physician CEOs. This study had three distinct objectives. The first was to describe the organizational variables for American Hospital Association (AHA) hospitals with CEOs who are physicians. The second objective was to analyze the organizational and market characteristics of hospitals with physician CEOs. The final objective was to examine the similarities and differences between hospitals that have a CEO who is a physician and those headed by a CEO who is not a physician. Institutional theory was utilized to form a theoretical model and to develop the relevant hypotheses. The study was a retrospective, cross-sectional study of over 5600 American Hospital Association (AHA) short-term, acute care hospitals located in the United States. Data sources utilized were the AHA’s Annual Survey of Hospitals, the Area Resource File, Centers for Medicaid and Medicare Services, HealthLeaders-Interstudy, and SK&A from 2007-2008. There were 118 hospitals out of 5,671 with a physician CEO in 2008. The descriptive statistics and multivariate logistic regression analyses revealed that although hospitals with physician CEOs are located in many different locations and types of hospitals, they are some attributes that indicate a greater likelihood. Hospitals with physician CEOs are most prevalent in the northeast. The multivariate logistic regression analyses revealed there is a greater likelihood that hospitals with physician CEOs are more likely to be larger, specialty, not-for-profit and non-church operated, teaching, and be in a market with higher physicians per capita. The study also found that there wasn’t more likelihood for a hospital to have a physician CEO when comparing with US News top hospitals, based on affluence of a market, based on the competition in the market, or the managed care penetration. The study identified several of the components and how they positively relate to the institutional theory model that was developed. The study also identified several limitations that could further be improved using additional research approaches and obtaining more data. Overall, the study has furthered the information available about hospitals with CEOs who are also physicians and their corresponding organizational and market characteristics.