CEO turnover is a defining event for hospitals. Although CEO turnover can help to steer organizations out of a crisis, a turnaround can also have negative consequences, including organizational failure. Despite potential negative consequences, hospitals have one of the highest CEO turnover rates of any industry. Although CEO turnover is a highly relevant phenomenon, our knowledge of the factors that determine CEO turnover is still inadequate. Addressing this research need, this study aims (1) to identify factors influencing variation in CEO turnover rates and (2) to reveal the motivations and underlying mechanisms of hospital CEO turnover. We conduct a quantitative and a qualitative study in a convergent parallel mixed-methods design. The quantitative study is based on an unbalanced panel dataset on 754 hospitals and 1,049 CEO turnovers for the period 2012-2020. We use logistic regressions to explain variation in CEO turnover rates based on factors related to CEO’s personal characteristics, hospital characteristics, and prior organizational performance. The qualitative study is based on semi-structured interviews with 21 hospital CEOs, board members, and hospital consultants, selected by a purposive sampling approach. We analyze the interview data using a two-step deductive-inductive coding process. The results of the quantitative study suggest that a better performance in several performance metrics such as technical efficiency, financial performance, and patient satisfaction, is associated with a lower probability of CEO turnover. Moreover, private for-profit hospital ownership type (positive association) as well as CEO age (U-shaped relationship) are significant factors influencing variation in CEO turnover rates. The results of the qualitative study reveal that CEO turnovers are to a large extent driven by financial pressures. Furthermore, interpersonal relationships within the hospital as well as between the CEO and the board of directors are crucial mechanisms in explaining hospital CEO turnover. This study enhances the literature by offering a comprehensive analysis of multifaceted factors influencing CEO turnover in hospitals. By integrating quantitative and qualitative insights, it underscores the importance of performance metrics, ownership structures, and interpersonal relationships. These findings are relevant for decision-makers, providing a multi-perspective overview of factors affecting CEO turnover and informing strategic succession planning to ensure smooth transitions.
