Advisor(s)
Nancy Borkowski
Committee Member(s)
Christy Lemak
Geoffrey Silvera
Kristine Hearld
Phillip Cendoma
School
School of Health Professions
Document Type
Dissertation
Department (new version)
Health Professions
Date of Award
9-11-2025
Degree Name by School
Executive Doctor of Science (DSc) School of Health Professions
Abstract
Background: Federally Qualified Health Centers (FQHCs) are essential providers of primary care in underserved communities but face growing risks of financial instability. Leader transitions, particularly at the executive level, may influence an organization's ability to recover from fiscal distress. This study examined whether executive succession—and the type of succession (internal vs. external)—was associated with financial turnaround among distressed FQHCs. Methods: Financial distress was assessed using the Modified Altman Z-Score, a validated indicator of fiscal health in nonprofit organizations. A longitudinal, quantitative design was used to analyze 850 FQHCs across the United States over a six-year period (2017–2022). Financial performance was measured in two ways: the difference in the modified z-score between 2017 and 2022 and with turnaround success, defined as an improvement from a distressed score in 2017 to a sustained average healthy score from 2018–2022. The primary independent variables were leadership change and succession type, and outcomes were evaluated using bivariate analysis and generalized estimating equations (GEE). Results: There was no statistically significant association between executive succession or succession type and financial performance. These findings suggest that leadership change alone may not be a key determinant of financial recovery among iv distressed FQHCs, highlighting the need for further exploration of other organizational or environmental factors that contribute to financial stability.
ProQuest ID
Recommended Citation
Amaro, Luis Orlando, "Fqhc Turnaround Success – Does Leadership Matter?" (2025). All ETDs from UAB. 7370.
https://digitalcommons.library.uab.edu/etd-collection/7370
