The U.S. health care delivery system faces serious challenges such as an increasing demand for services due to an aging population, unhealthy lifestyles, growth in the number of uninsured individuals, and an increase in chronic diseases. At the same time, the system has to cope with a limited supply of money, physicians, and nurses inferior quality of care delivered by U.S. hospitals. While the U.S. hospital industry is adapting to address these issues, not much progress in improving the quality of care delivered has been made over the last decade. However, theories exist that management systems, organizational traits, and leadership are key factors for hospitals to improve quality of care outcomes. This study takes a holistic look at these factors to identify and analyze critical drivers for better quality of care outcomes of U.S. hospitals. The study also aims to identify differences between chief executive officers' (CEOs) leadership traits among lean (mediocre performance), high (top 20th percentile), and low performing (bottom 20th percentile) U.S. hospitals in regards to their quality of care measures. Two separate online surveys were conducted. The first online survey was targeted at all 4,697 U.S. hospitals that are required to disclose quality of care measures to the Federal government. Results of this first survey revealed that two management system factors drive quality of care outcomes of U.S. hospitals. Furthermore, findings also show that critical access hospitals have a lower quality of care performance than acute care hospitals. Thus, based on the results from this survey, we concluded that management system factors are main drivers of hospital performance, whereas organizational trait and leadership factors did not significantly contribute to hospital performance. A second survey to CEOs and CEO followers in 9 selected hospitals found significant differences between CEO traits leading lean and low performing hospitals, and, to a lesser degree, significant differences among high and low performing hospitals. However, the study did not find any significant differences in CEO traits between lean and high performing hospitals. Findings also include that some management system factors differed significantly between lean and high performing hospitals, but no evidence for such differences could be found between lean and high and high and low performing hospitals, respectively. These results suggest that management systems and CEO leadership traits play an important role in determining U.S. hospital performance as measured by their quality of care. / Ph. D.

Understanding managerial behavior and its underlying motivations is of key interest in times where the role of business in society is generally viewed critically. While CEO influence on strategy making processes is almost undisputed, little attention has explicitly been paid to how CEO values and the characteristics of the top management team (TMT) interact in shaping corporate strategy making. This is surprising if one follows the assumption that top managers who work closely together will by necessity influence each other's actions. Hence, we would expect the CEO-TMT interface to be vital in understanding how leadership influences strategy making. To address this, we propose a model in which the personal values of the CEO have a direct effect on the characteristics of corporate strategy making processes yet where this association is moderated by TMT diversity. We test the model with data from Austria and Germany obtained through a large-scale survey conducted in spring 2015 and a follow-up survey conducted in fall 2015 and find general support for our model. CEO values geared towards self-transcendence (as opposed to selfinterest) seem to be associated with more formal strategy making processes, while values geared towards openness to change (as opposed to conservation) are found to be associated with more flexible and less externally open ones. TMT diversity moderates all of these relationships. Our results add to upper echelon theory as well as to strategy process research and highlight promising avenues for future research.