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Good Governance Model for the Healthcare Administration: A Case Study of

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International Journal of Management (IJM)
Volume 11, Issue 11, November 2020, pp. 248-262. Article ID: IJM_11_11_025
Available online at http://www.iaeme.com/ijm/issues.asp?JType=IJM&VType=11&IType=11
Journal Impact Factor (2020): 10.1471 (Calculated by GISI) www.jifactor.com
ISSN Print: 0976-6502 and ISSN Online: 0976-6510
DOI: 10.34218/IJM.11.11.2020.025

© IAEME Publication Scopus Indexed

GOOD GOVERNANCE MODEL FOR THE

HEALTHCARE ADMINISTRATION: A CASE
STUDY OF PUBLIC HOSPITALS IN PAKISTAN
Dawood Nawaz
Ph.D. (Scholar) at Ghazali Shafie Graduate School of Government,
Universiti Utara Malaysia, Sintok Keddah Darul Aman, 06010, Malaysia.

Ahmad Martadha B Mohamed

Professor at Ghazali Shafie Graduate School of Government,
Universiti Utara Malaysia, Sintok Keddah Darul Aman, 06010, Malaysia

ABSTRACT
The main objective of this research is to assess the role of good governance in the
health outcomes of the healthcare administration of public hospitals in Pakistan. The
role of better public healthcare hospitals in the development of any country is an
undeniable fact. The previous studies emphasized on such aspects that affect the
performance of public healthcare hospitals performance, but the role of good
governance and health outcomes have been ignored. This research examines the impact
of good governance determinants such as accountability, equity, responsiveness, and
transparency on the health outcomes of public healthcare hospitals. The current
research applied a quantitative research method using cross-sectional survey design. A
questionnaire was distributed to collect the data from 238 employees working in
Pakistani public healthcare hospitals. The collected data was analyzed using structural
equation modelling (SEM) with the help of SmartPLS 3.2.7, a widely used data
analytical tool. The results of the analysis showed that health outcomes have significant
relationship with good governance determinants; equity, responsiveness, and
transparency except accountability of public healthcare hospitals. The public
healthcare administration at different levels is expected to enhance competencies of
conducting high quality services, research and contribution to wider society through
utilization of scarce resources and creating a good governance environment to
maximize health outcomes from the available strength and opportunities and cope up
with challenges. The findings and recommendations are expected to add value to the
current body of literature in healthcare sector and particular value addition will be for
the Pakistani public as well as private healthcare sector.

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 Dawood Nawaz and Ahmad Martadha B Mohamed

Keywords: accountability, equity, responsiveness, transparency, health outcomes,

public healthcare hospitals.
Cite this Article: Dawood Nawaz and Ahmad Martadha B Mohamed, Good
Governance Model for the Healthcare Administration: A Case Study of Public Hospitals
in Pakistan, International Journal of Management, 11 (11), 2020, pp. 248-262.
http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=11&IType=11

1. INTRODUCTION
The good governance has been gained a great importance in all perspectives of life. It suggests
that the government institutions frames and realizes the sound decisions, policies and programs
to increase the public services quality in keeping the aim of effective development and efficient
economic growth ( Mahmood et. al., 2020 ; Suhardi, Huda, & & Nazopah , 2020; Grindle, 2004;
Hellman, Jones, Kaufmann, & Schankerman, 2000; Rivera & Batiz, 2002). These type of sound
decisions, policies and programs discuss the determinants of good for example law and order,
transparency, equity, consensus-oriented, accountability, responsiveness, equality, justice,
effectiveness and efficiency (Lockwood, 2010).
The governance can define in the healthcare administration as the transparent rules and
regulations administer by the accountable management and strong supervision (WHO, 2015).
Mooketsane and Phirinyane (2015) stated that the governance in healthcare has recognized as
an accretion of significant principles like transparency, accountability as well as equity in which
healthcare system perform various functions. Further, WHO defined the governance for the
health in terms of stewardship and strategic policy frameworks with overall control, effective
accountability, proper supervision, and inducements.
Pappas et al. (2009) investigated that there is 75 percent of healthcare facilities are only
providing by the private healthcare sector in Pakistan since many years which is very alarming
situation for the public healthcare sector. Further, Pakistan has ranked very low in the healthcare
with comparing other Asian countries in 2018 which can be shown in the table given below.

Table 1 Healthcare Index for South Asian & South East Asian Countries 2020
Countries Healthcare Index Rank 2018
Thailand 77.95
Sri Lanka 72.53
Singapore 70.84
Malaysia 68.10
Philippines 67.47
India 67.13
Pakistan 60.59
Indonesia 60.48
Vietnam 57.70
Nepal 56.88
Iran 51.70
Bangladesh 42.80
Source: Global Burden of Diseases, 2020
WHO and Mathers (2017) explained that presently the situation of health sector in Pakistan
is very vulnerable because there is a burden of diseases, like nutritional deficiencies as well as
infectious diseases. These diseases are not being controlled and due to these issues, there is
about 46 percent of disease burden is facing in the Pakistan. All of these problems are being

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 Good Governance Model for the Healthcare Administration: A Case Study of Public Hospitals in
Pakistan

faced only because of the poor health administration and lack of good governance. Additionally,
about 12 percent reproductive healthcare issues and 10 percent non-communicable diseases of
the total burden of diseases are accounted in Pakistan.
According to WHO (2018), Pakistan faced the issue of 18,500 annually maternal deaths,
65.8 infant mortality rate on per 1000, and 96 mortality rates among the under-5 age of child
on per 1000 in comparing other countries in the region of South Asia. The health situation of
Pakistan is very bad due to the unfavorable health outcomes. Pakistan is ranked on 154 in 195
countries in the healthcare access and quality ranking of South Asian countries which can be
show in the Table 2 given below.

Table 2 Healthcare Access and Quality Ranking of South Asian Countries 2018
Countries HAQ Index Rank 2018
Afghanistan 191
Pakistan 154
Nepal 149
India 145
Bhutan 134
Bangladesh 132
Sri Lanka 71
Source: Global Burden of Diseases, 2018
The various good governance elements such as transparency, equity, law and order,
accountability, justice and fairness, efficiency and effectiveness, responsiveness, equal
participation, as well as rule of law become the employees more effective, loyal, and
accountable in the delivery of public services. The policy makers and government have great
need to analyze the main issues facing by the healthcare administration and frame effective
health plans, policies and programs that will be affordable in the future for the better health
outcomes.

2. LITERATURE REVIEW
The governance and good governance are broad concepts so that’s why there is a large amount
of data on governance and good governance is available on the various perspectives by the
different authors and institutions such as IMF, World Bank, United Nations, and many others
(Armijo, 2004; Beck et al. 2001; Brinkerhoff & Goldsmith, 2005; Hellman, Jones, &
Kaufmann, 2000; Kaufmann, Kraay, & Zoido-Lobatón, 2002; Mardiasmo, Barnes, & Sakurai,
2008). Further, good governance has increased the awareness of public in the different functions
and matters about government departments and it becomes an important feature in the manner
of nation’s competency to analyze and understand the standards of good governance in all over
the world (Arthur et al. 2012).
Rotberg (2014) stated that good governance also affirms that the social, political,
developmental as well as economic priorities are determining in the society on broad level and
the basic needs and demands of the poor and the most vulnerable society is being discuss in
policymaking. Moreover, as donor, public officials and researchers seek to understand how to
improve the performance of health systems, it is important to evaluate and understand good
governance and health outcomes in the health system (Brinkerhoff & Brinkerhoff, 2011;
Brinkerhoff & Bossert, 2013; Nishtar, 2010). The notion of good governance in healthcare
systems and health outcomes has become one of the complex and often overlooked topics in
health policy discussions that regularly engage in discussion and inspire new research (Jaffari,

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 Dawood Nawaz and Ahmad Martadha B Mohamed

Hajinabi, & Riahi, 2018). Although it can be used easily and reliably by policy makers to
administer health outcomes, a practical tool has not yet been developed.
Good health governance has gained importance as health funds increase and donors demand
greater accountability, responsibility and transparency from recipients (Lewis, 2006; Lewis &
Pettersson, 2009; Ramiro et al., 2001; Vian, 2008; Vian, Savedoff, & Mathisen, 2010). In
addition, good governance in health has discussed across various dimensions, including global
governance, corporate governance, governance in development, and how the private sector can
govern in providing public services (Barbazza & Tello, 2014). However, when it comes to
health outcomes, much of the literature on good governance is more theoretical and less
conducive to the practices and
Several studies have discussed the effects of different areas of governance and selected
aspects of good governance on health outcomes, for example, Brinkerhoff (2004); Brinkerhoff
& Bossert (2008); Brinkerhoff & Bossert (2013); Chaudhury et al. (2006); Lagomarsino et al.
2012; Nishtar (2010); Ramiro et al. (2001); Vian (2008); WHO (2008); (2009); (2010); (2013);
(2015); World Health Statistics (2018). Indeed, some studies have strongly evaluated the depth
and impact of certain elements of good governance on health outcomes (Gupta et al., 2002;
Lewis, 2006; Pyone, Smith, & van den Broek, 2017; Qarani & Kanji, 2015).
Most literature on good governance and health outcomes has focused on the dimensions of
good governance, such as the degree of government effectiveness, the degree of corruption, and
the participation of community in development. Generally, these segments assess proxy
indicators of health outcomes, such as immunization rates, the percentage of low birth weight
babies, and levels of child mortality (Bein et al. 2017; Brinkerhoff & Bossert, 2013). In addition,
the governance assessment in the health system develops a framework that proposes a series of
explanatory questions to be answered by key stakeholders, such as how it will be used by health
stakeholders, and how government donates (Islam, 2007; Islam et al., 2012). This framework
provides a comprehensive range of content that can be examined and even suggested which
stakeholders are interviewed.
Health outcomes have in the past few years been seen as declining due to population growth,
which has become a burden on various institutions in the state and has linked the private sector
to the gap between rising demand and the public health care system (WHO & Mathers, 2017).
The private healthcare sector is an important resource for child health services, outpatient
consultations, maternity health services, and other health services due to the intensive health
services and treatment. Therefore, the role of private healthcare sector in the delivery of health
services has greatly increased (Haqq et al. 2019).
According to the latest Web World Hospitals Ranking (2016), 19 of the top 20 hospitals in
South Asia are in India, one in Bangladesh, and none in Pakistan. Also, according to this
ranking, the best public sector hospital in Pakistan is 5,911 in the world. Statistics showed that
the performance of Pakistan's healthcare sector (hospitals) in the South Asian region, in the
Asian region and around the world is unsatisfactory. Health infrastructure is underdeveloped
throughout Pakistan, especially in South Punjab. The basic health units in rural areas are not
well equipped. Aziz and Hanif (2016) empirically researched that South Punjab rural population
of Pakistan is the lowest in terms of primary and tertiary health care. Providing quality
healthcare has never been a priority area, especially for planners or policy makers in South
Punjab.
Health administrators and the government's policy makers have realized that the allocated
health resources cannot achieve deliberate results without considering good governance.
Rather, it is more important when the government brings a substantial amount of funds for
certain diseases and improves the health care delivery system (Danila & Mohamed, 2013).
Therefore, weaknesses in health management have warned to undermine the effective use of

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 Good Governance Model for the Healthcare Administration: A Case Study of Public Hospitals in
Pakistan

funds and to disrupt the planned targets for hospital’s health programs and policies. Further,
there are a lot of differences between the districts of the same province (Hassan, Mahmood, &
Bukhsh, 2017).
Let us consider the case of the urban and rural areas of Punjab province, antenatal birth in
the first five and lower five districts; the total coverage is about 68%. In urban areas, about 79%
of pregnant mothers have access to antenatal care while this figure for rural areas is only 60%
(UNDP, 2015). Further, many health facilities have been in poor condition and many have been
taken seriously. Supply of drugs, especially Rubella, Measles, and Mumps (MMR)
vaccinations, was significantly lower in many public health centers (Hassan et al. 2017). In
addition, the WHO reported that 300 children died of Measles in December 2012. Pakistan also
lacks skilled health professionals (WHO, 2015). The absence of staff is a major problem for the
public health system and the government especially in the poorest part of urban areas.
Today, a weak accountability and transparency system is common in public hospitals that
is weakening the delivery of health services (Kiani, 2013). In Pakistan, poor health outcomes
have led to poor governance and weak health services at the national level (Aziz & Hanif, 2016).
In addition, previous studies have emphasized that deaths and illnesses in Pakistan are solely
due to caustic health activities, such as unhealthy food and body diseases, excessive use of
alcohol, tobacco, and vine (Qarani & Kanji, 2015). Further, increasing demand of better health
facilities, doctors, and hospitals is due to demand for improved healthcare system, patient safety
and better health outcomes (Baird et al. 2014). All health issues have raised concerns and
seriously damaged the dependence of the public and others health departments (Nutbeam,
2008).
The development of the health sector, which is certainly assessed with other sectors, is very
slow, and the errors or problems in the health sector continue to prevail (Lobo & Meteus, 2013).
The government institutions in Pakistan do not focus on the provision of public facilities to
efficiently contribute to providing equal or fair service at the local level (Mahmood & Bashir,
2012). The current government structure in Pakistan lacks accountability, equity,
responsiveness and transparency. Therefore, there is a lack of public participation and
enforcement of proper policies, which negatively impact the needs and opportunities of the
population. (Ali, 2015).
In addition, some basic services, such as essential health services, healthy food and water,
are not subdivided at local levels that negatively impact the lives of rural and underdeveloped
areas (Irfan et al. 2012). Estimates of health outcomes in Pakistan indicate that children under
the age of five are approximately 4.8 percent underweight and 12 percent are thoroughly
underweight (World Health Statistics, 2018). Children represent the most vulnerable group in
the community and are not much supported by past developmental events and social
development (Manary, Boulding, Staelin, & Galickman, 2013). Countries like Bangladesh and
Nepal have made more significant improvements in health outcomes than Pakistan, which is
far from offering health outcomes.
Good governance is needed to focus on long-term health outcomes. Accountability is
difficult when the parallel flows of officers and administrators do not work together. Health
equity is not very high on the policy agenda, so it creates a problem of accessibility and
affordability for the poor and low-income groups. The responsiveness of the health services is
not properly monitored so it causes a lack of coordination among the relevant institutions, and
there is no proper transparency in the health sector which distracts the public's confidence on
the health sector and the implementation of health policies, programs and innovations. This
current research aims to examine the impact of good governance determinants such as
accountability, equity, responsiveness, and transparency on the health outcomes of public
healthcare hospitals.

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 Dawood Nawaz and Ahmad Martadha B Mohamed

3. RESEARCH FRAMEWORK
The setting up of this framework is carried out right after broadly literature assessment of the
concept of Health outcomes (DV) from the study of Savedoff (2009) and Good Governance
determinants; accountability, equity, responsiveness and transparency(IVs) which taken
because these determinants mostly used in the various studies, like Kaufmann et al., (2005;
2007; 2009), Siddiqi et al., (2009), Danila & Mohamed (2013) and after the broad study of
these organizations; World Bank (WB), United Nations Development Programme (UNDP),
United Nations (UN), International Monetary Fund (IMF), Asian Development Bank (ADB),
African Development Bank (AfDB), International American Development Bank (IADB),
European Bank for Reconstruction and Development (EBRD), Organization for Economic
Cooperation and Development (OECD), European Union (EU), European Commission (EC)
and governance theory proposed by the Lynn et al. (2001) and Savedoff (2009).

Figure 1 Research Framework

4. THEORETICAL FRAMEWORK

Figure 2 Model of Good Governance Determinants to Health Outcomes

Source: Adapted from Savedoff (2009)

5. DATA & METHODOLOGY

This study employs a quantitative research design to analyze the good governance of healthcare
administration of public hospitals in the Multan district, Pakistan. For this study, the survey
questionnaire was distributed among the 238 employees (doctors, nurses, administrative staff)
of the public hospitals (i.e., Tertiary care and Teaching Hospitals, District Headquarter, Tehsil
Headquarter, and Rural Healthcare) located in the Multan district. The data was collected with
the help of a self-administered questionnaire. The questionnaire contains two section in which

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 Good Governance Model for the Healthcare Administration: A Case Study of Public Hospitals in
Pakistan

the first section asks about the demographic information and the second section was on the main
constructs, namely, health outcomes, accountability, equity, responsiveness, and transparency.

6. MEASURES
The measures for Health Outcomes was adapted from the WHO report (2018). The scale to
measure Accountability was adapted from the study of Cleare (2011). The measurement of
Equity and Responsiveness were adapted from WHO report (2000) while the measure for
transparency was adapted from the study of Rawlins (2008) and Barbazza & Tello (2014) as
given in Table 3.

Table 3 Measurement Scale of Variables

Number of Likert
Variable Source
Items Scale
Health Outcomes WHO (2018) 24 1-5
Accountability Cleare (2011) 8 1-5
Equity WHO (2000) 8 1-5
Responsiveness WHO (2000) 10 1-5
Transparency Rawlins (2008); Barbazza and Tello (2014) 10 1-5

7. DATA ANALYSIS
The descriptive analysis of demographics of the respondents showed that there were 52.9%
male and 47.1% female respondents. Most of the respondents were of the age group 26-50
years. The further details of the demographic profile of respondents is given in Table 4 below.

Table 4 Demographic Information

Demographic Factors Frequency %
Age
25 or below 33 13.9
26-35 110 46.2
36-50 66 27.7
51 and above 29 12.2
Gender
Male 126 52.9
Female 112 47.1
Residence
Urban 158 66.4
Rural 80 33.6
Educational Level
MCPS/FCPS/Ph.D. 82 34.5
MBBS/BDS/Nursing/M.Phil. 113 47.5
Masters/Bachelors (16 Years) 23 9.7
Bachelors (14 Years) 20 8.4
Employment Status
Doctors 99 41.6
Nurses 94 39.5
Administrative Staff 45 18.9
Health Status

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 Dawood Nawaz and Ahmad Martadha B Mohamed

Healthy 196 82.4

Physical Illness 12 5.0
Psychological Illness 8 3.4
Common Diseases 22 9.2

8. FINDINGS & RESULTS

Further analysis of the measurement model such as construct reliability and validity were
executed using structural equation modelling (SEM) technique, using partial least squares
(PLS) with Smart PLS 3.0. Kashif, Zarkada and Ramayah (2016) mentioned that SmartPLS is
a second-generation analysis software that can be used to test complex models with latent
variable. In order to assess the measurement model, the procedure suggested by Anderson and
Gerbing (1988) was followed. In this two-step approach, the first step is adapted to test the
measurement model and a second step for the structural model in order to test the hypothesis.
In the measurement model, CFA technique was used to assess the items of the constructs
and the items with lower factor loadings were removed. The construct reliability and validity
were assessed using the criterion suggested by Fornell and Larcker (1981), in which the
construct validity is assumed when the value of the composite reliability is 0.70 or above. The
constructs will be assumed to have acceptable construct validity when the value of Average
Variance Extracted (AVE) is 0.50 or above. In the current study, both reliability of construct
validity and composite reliability were established, and all the constructs fulfilled the criterion
given by Fornell and Larcker (1981). The structural model was run using PLS-SEM.
In order to assess the measurement model, the literature suggests considering loading on
three indicators, namely average variance extracted (AVE), composite reliability (CR) and
convergent validity (CV). CV ensures whether the items of measurement represent the one and
same underlying construct. As per criterion suggested by Chin, Gopal and Salisbury (1997) and
Gholami et al. (2013), the loadings of the indicators should be above 0.6. The value of AVE
should be above 0.5 and CR should be above 0.7. The fulfilment of these criteria assures the
fitness of the measurement model. As indicated in Table 5, all the values were above the
recommended values and ensured the value of CV is acceptable.

Table 5 Measurement Model

Constructs & Items Loadings CR AVE
ACC1 0.835
ACC3 0.790 0.805 0.581
ACC5 0.650
EQU2 0.712
EQU3 0.843
EQU6 0.628 0.822 0.539
EQU7 0.735
RES4 0.808
RES5 0.832
RES6 0.805
RES7 0.801 0.893 0.585
RES8 0.747
RES9 0.561
TRAN1 0.788
TRAN2 0.628

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 Good Governance Model for the Healthcare Administration: A Case Study of Public Hospitals in
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Constructs & Items Loadings CR AVE

TRAN3 0.747
TRAN5 0.796 0.863 0.515
TRAN8 0.683
TRAN9 0.647
HO2 0.641
HO3 0.717
HO4 0.711
HO7 0.672
HO8 0.652
HO9 0.689
HO11 0.742
HO14 0.780 0.935 0.509
HO15 0.790
HO17 0.714
HO18 0.684
HO19 0.703
HO21 0.782
HO23 0.688
In the next step of the analysis, the analysis for the discriminant validity (DV) was done to
ensure that the construct in the models differs from each other. Other researchers for instance
Arshad and Ibrahim (2019) also used AVE for discriminant validity in their study. The value
of square root of AVE was compared with correlation among the constructs. The cases where
the value of square root of AVE is greater than correlation value in row and column confirmed
that the measures are discriminant. In Table 6, the values of square roots of AVE in the rows
and columns were higher than the correlations, showing that constructs are discriminant.

Table 6 Discriminant Validity

Latent Variables 1 2 3 4 5
Health Outcomes 0.713
Accountability 0.670 0.762
Equity 0.507 0.599 0.734
Responsiveness 0.644 0.491 0.421 0.765
Transparency 0.498 0.709 0.664 0.577 0.718
Note: Value on the diagonal (bold) represents the square root of AVE and while off the
diagonals are correlations

9. HYPOTHESIS TESTING
After satisfactory results of the measurement model, hypotheses testing was conducted using a
structural model with bootstrapping of 7000. The results of proposed hypotheses testing (H1: β
= -0.018, p > 0.05) showed that Accountability has insignificant influence on health outcomes.
The results of 2nd hypothesis showed that Equity has a significant influence on health outcomes
(H2: β = 0.0177, p < 0.001). On the other hand, Responsiveness has also a significant influence
on health outcomes (H3: β = 0.331, p < 0001). Finally, the results of last hypothesis showed
that Transparency has significant influence on health outcomes (H4: β = 0.602, p < 0.001).
Based on the results H2, H3, and H4 are supported but the results do not support H1 as depicted
in Table 7 given below.

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 Dawood Nawaz and Ahmad Martadha B Mohamed

Table 7 Hypothesis Testing

Hypotheses Relationship β SE T-value Sig.
H1 ACC  HO -0.018 0.030 0.578 0.563
H2 EQU  HO 0.177 0.035 5.023 0.000
H3 RES  HO 0.331 0.035 9.572 0.000
H4 TRAN  HO 0.602 0.045 13.398 0.000
Hair, Ringle, and Sarstedt (2013) recommended that Q2 should be calculated. Q2 can
effectively be used as a criterion for predictive relevance. Based on blindfolding procedure, Q2
evaluates the predictive validity of a large complex model using PLS. While estimating
parameters for a model under blindfolding procedure, this technique omits data for a given
block of indicators and then predicts the omitted part based on the calculated parameters (Hair
et al., 2013). As the Q2 value of 0.449 for health outcomes is larger than 0 as per criterion given
by Fornell and Larcker (1981), the model can be considered to have sufficient predictive power.

Figure 3 Hypothesis Testing Results

10. DISCUSSION & CONCLUSION

In studies about good governance, a lot of emphasis has been given to the importance of
accountability, equity, responsiveness, and transparency in the healthcare sector (Danila &
Mohamed, 2013). The current study considered the determinants of good governance;
accountability, equity, responsiveness and transparency to assess the influence on health
outcomes, taking into the context of good governance theory. The findings of the research
provide a strong empirical justification for the good governance and its determinants on the
health outcomes of the public healthcare hospitals.
The findings revealed that accountability has insignificant influence on health outcomes
among the employees of public healthcare hospitals and there is a great need of accountability
among the employees of public healthcare hospitals. So that’s why, many issues regarding the
accountable administration are facing by the public in the public healthcare hospitals. This
finding is strongly in the support of previos study by Lee (2007) which concluded that there is
insignificant relationship between accountability and health outcomes because many of the

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 Good Governance Model for the Healthcare Administration: A Case Study of Public Hospitals in
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problems with the unsatisfactory consequences of the health system include the quality,
accessibility and affordability of services experienced by patients with different socioeconomic
backgrounds. Additionally, the study conducted by Brinkerhoff (2004) and Brinkerhoff &
Bossert (2013) also revealed that the lack of partnership and coordination caused the
accountability mechanisms to be ill-defined, making it unclear who was accountable for what,
thus negatively affecting the efficiency of the health system and its outcomes.
Further findings showed that equity has a significant influence on health outcomes of the
employees of public healthcare hospitals. This finding contradicts findings in some of the
previous literature and this finding is in the support of the Wendt (2012), who empirically
investigated that equity is necessary for the healthcare system because if equity lies in
healthcare, then the health outcomes can be equal for all.
Similarly, responsiveness has also significantly influence on the health outcomes among
the employees of public healthcare hospitals. The finding is supported by the studies made by
Mohammadi and Kamali (2014), who documented the significant influence of responsiveness
on health outcomes and declared that more than half of the inpatients rated overall
responsiveness as good (58.4%) in health outcomes.
Moreover, the finding of transparency concluded that there is a significant influence of
transprency on health outcomes and this finding is in the support of previous study done by
Kaini (2013) who stated that one of the foundations of healthcare governance, transparency, or
openness has a positive effect on health outcomes.

11. IMPLICATIONS FOR THE FUTURE

This reaserch has used the four good governnace determinnats; accountability, equity,
responsivness and transparency while other determinants can use in the future to access the
good governnace of hospitals. Further, this study has chosen the public heacthcare hospitals in
Pakistan while private hospiatls can chose for the future research. Public healthcare hospiatls
in Punjab provine of Pakistan are focused in this study while there is a opportunity to select
public as well as private hospiatls of other provinces for the future studies. Moreover, future
studies can do the comparaive analysis to access the good governance of public and private
healthcare hospitals in Punjab. Most important, this study has only focused on the employees
of public healthcare hospitals while employees, stakeholders, patients of public and priavte
healthcare hospiatls can involve in the future research.

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