CEO turnover in German hospitals

Chief executive officers (CEOs) play a pivotal role in shaping organizational strategy, performance, and legitimacy. Consequently, CEO turnover represents a critical event that can either enable organizational renewal or trigger instability. While prior research—primarily focused on the corporate sector—offers mixed evidence on its determinants and consequences, growing attention has been directed toward the role of contextual conditions in shaping these effects.This dissertation examines CEO turnover in the hospital sector, a context characterized by high societal relevance, strong regulatory constraints, and comparatively high turnover rates. Despite the importance of stable leadership for ensuring high-quality care, existing research on hospital CEO turnover remains fragmented and methodologically inconsistent.To address these gaps, the dissertation comprises three studies. First, a systematic literature review synthesizes empirical evidence, identifying a broad range of predictors and highlighting limited and inconclusive findings regarding outcomes. Second, a mixed-methods study combining panel data from hospitals with qualitative interviews shows that CEO turnover is driven by the interplay of multiple factors, with poor organizational performance emerging as a central predictor. Third, a quasi-experimental analysis of hospitals demonstrates that CEO turnover is associated with short-term declines in technical efficiency and patient satisfaction, while effects on financial performance remain inconclusive.Overall, the findings suggest that CEO turnover in hospitals is a multifaceted phenomenon with context-dependent drivers and predominantly short-term disruptive effects. The dissertation contributes to a more nuanced understanding of leadership transitions in healthcare and provides implications for research and practice, particularly regarding evidence-based succession planning.