Advisor(s)
Nancy Borkowski
Committee Member(s)
Geoffrey Silvera
Philip Cendoma
Robert Weech-Maldonado
Seongwon Choi
School
School of Health Professions
Document Type
Dissertation
Department (new version)
Administration/Health Services
Date of Award
9-11-2025
Abstract
This study examines the influence that leaders have on the performance of Federally Qualified Health Centers (FQHCs) in the US. The framework through which the study examines this relationship is the Upper Echelons Theory (UET), which posits that managers and leaders take actions that shape the organization they lead, and these actions are based on a confluence of experiential and characteristic factors. The current study focuses on a leader’s influence through three proxies, viz. educational background, role tenure, and sex, on the organizational performance of FQHCs. Performance is captured using both financial and quality metrics. Data for the study was sourced from secondary databases, to which additional primary data was added. The study was conducted using a retrospective, cross-sectional design. The study had a dual aim. First, to explore the influence leaders may have on FQHC performance using the UET as a framework. Next, to use these findings as the basis for recommendations to organizations and leaders to improve the FQHC program. The study results point to an inconsistent influence of leaders on the performance of FQHCs. Though non-clinically trained leaders led Centers which reported superior performance as measured by current ratios, this finding was not consistent when total margin and grant dependence ratio were considered. Organizations led by male leaders consistently outperformed those led by their female peers on financial performance, though this relationship was statistically significant only for grant dependence ratio. Finally, of the three traits evaluated, role tenure alone influenced Health Center Quality Leader (HCQL) badge performance in a statistically significant manner, with Centers led by leaders with longer role tenures likelier to perform better with regards to the quality of care provided. FQHC boards could use these findings to identify, develop, and train future talent. We also found that other demographic and organizational factors, such as the proportion of uninsured patients in the payer mix, and organizational age influenced FQHC financial and quality of care performance more so than organizational leaders themselves and their traits. Policymakers could use these findings to address challenges faced by underperforming Centers in a more targeted manner.
ProQuest ID
Recommended Citation
Upadhye, Devdutt Shriram, "Exploring The Influence Of Leadership On The Organizational Performance Of Federally Qualified Health Centers In The United States Through The Lens Of The Upper Echelons Theory" (2025). All ETDs from UAB. 7340.
https://digitalcommons.library.uab.edu/etd-collection/7340
