Italian healthcare organizations facing new dimensions: changes in governance structure

Private and public organizations facing merger processes may consider reconfguring the size, composition, and mechanisms used by the strategic apex. In Italian local health organizations (LHOs), the strategic apex had to face challenges arising from an increase in size and its impacts on diferent governance areas. The aim of this study is to highlight the role of the top management team in shaping the conditions of governance, and link these conditions to certain internal and external characteristics of the specifc LHO and to the behavior and vision of the CEO. The study used qualitative techniques to examine the cases of three of the largest Italian LHOs that had undergone merger processes in recent years. The results show how changes in the organizational size impact the structure and mechanisms of the strategic apex. In particular, this study identifes three main governance strategies.