Board gender diversity and performance in gazelles: evidence from a sample of Italian private hospitals


Gender diversity
financial performance

How to Cite

Mauro, M., Giancotti, M., Ferrari, E. R., & Cattafi, G. (2023). Board gender diversity and performance in gazelles: evidence from a sample of Italian private hospitals. Piccola Impresa Small Business, (2).
Received 2023-02-24
Accepted 2023-07-31
Published 2023-12-28


Purpose: This paper examines the influence of board composition in terms of gender diversity on the performance of high-growth firms, offering evidence from the health sector.

Methodology: The sample is composed of 27 startups operating in the health sector. Enterprises are born in Italy in 2014 and became gazelles in 2018 or 2019, respectively, in the fourth or fifth year of life. To analyse the effect of board gender diversity, multiple regression models were utilised, using return on assets (ROA) as a measure of financial performance.

Findings: Results show that there is a statistically significant and positive relationship between board gender diversity and financial performance. In other words, as the percentage of women on board of directors increases, financial performance grows by approximately 6.41%.

Originality of the study: The impact of board gender diversity on firms' performances is widely investigated in the literature. However, this study is original both for the type of firms (gazelles) and for the sector investigated (private hospitals).

Practical implications: Managers of high-growth startups may find advantages in including women in executive and board positions. This is particularly relevant for the private healthcare sector, where governance structure plays a key role in achieving performance objectives.


Abdelzaher, A., & Abdelzaher, D. (2019). Women on boards and firm performance in Egypt: Post the Arab Spring. The Journal of Developing Areas, 53(1).

Adams, R. B., & Ferreira, D. (2009). Women in the boardroom and their impact on governance and performance. Journal of Financial Economics, 94, 291-309.

Adams, R. B., & Funk, P. (2012). Beyond the glass ceiling: Does gender matter? Management Science, 58(2), 219-235.

Adams, R.B., Hermalin, B.E., & Weisbach, M.S. (2010). The Role of Boards of Directors in Corporate Governance: A Conceptual Framework and Survey. Journal of Economic Literature, Vol. 48 No. 1, pp. 58-107.

Adler, R. D. (2001). Women in the executive suite correlate to high profits. Harvard Business Review, 79(3), 30-32.

Aguinis, H., & Glavas, A. (2012). What we know and don’t know about corporate social responsibility: A review and research agenda. Journal of management, 38(4), 932-968.

Ahern, K. R., & Dittmar, A. K. (2012). The changing of the boards: The impact on firm valuation of mandated female board representation. Quarterly Journal of Economics, 127(1), 137-197.

Ahmadi, A., Nakaa, N., & Bouri, A. (2018). Chief Executive Officer attributes, board structures, gender diversity and firm performance among French CAC 40 listed firms. Research in International Business and Finance, 44, 218-226.

Ali, M., Ng, Y. L., & Kulik, C. T. (2014). Board age and gender diversity: A test of competing linear and curvilinear predictions. Journal of Business Ethics, 125, 497-512.

Arfken, D. E., Bellar, S. L. and Helms, M. M. (2004) The Ultimate Glass Ceiling Revisited: The Presence of Women on Corporate Boards, Journal of Business Ethics, 50, 177-186.

Arioglu, E. (2020). The affiliations and characteristics of female directors and earnings management: evidence from Turkey. Managerial Auditing Journal, 35(7), 927953.

Asad, S., & Georgakakis, D. (2023). Diversity on corporate boards and shareholder activism: an intersectionality approach. In Research Handbook on Diversity and Corporate Governance (pp. 113-123). Edward Elgar Publishing.

Athanasopoulou, A., Moss-Cowan, A., Smets M., & Morris T. (2018). Claiming the corner office: Female CEO careers and implications for leadership development. Human Resource Management, 57: 617-639.

Bacchin, S., Capo, F., & D’Agostino, L. M. (2022). Gender Board Composition and Performance in Italian Start-Ups. In ICGR 2022 5th International Conference on Gender Research, Academic Conferences and publishing limited.

Barron, J. M., & Waddell, G. R. (2003). Executive rank, pay and project selection. Journal of Financial Economics, 67(2), 305-349.

Bass, B.M., & Avolio, B.J. (1990). Developing transformational leadership: 1992 and beyond. Journal of European Industrial Training, 14, 21-27.

Bear, S., Rahman, N., & Post, C. (2010). The impact of board diversity and gender composition on corporate social responsibility and firm reputation. Journal of business ethics, 97(2), 207-221.

Belfiore, A., Cuccurullo, C., Aria, M. (2022). Financial configurations of Italian private hospitals: an evolutionary analysis. Health Policy, 126(7).

Bhagat, S., & Black, B. (2001). The non-correlation between board independence and long-term firm performance. J. CorP. l., 27, 231.

Bianchi, M. T., Morrone, C., Ricco, S., & Faioli, D. (2020). Female governance and performance. Piccola Impresa/Small Business, (3).

Birch, D. L. (1979). The job generation process. M.I.T. Program on Neighborhood and Regional Change. Cambridge, Mass. 1979.

Birch, D. L., & Medoff, J. (1994). Gazelles. In Solmon, L. C., & Levenson, A. R. (Eds.), Labor markets, employment policy and job creation (pp. 159-167). Westview.

Bocquet, R., Le Bas, C., Mothe, C., & Poussing, N. (2019). Strategic CSR for innovation in SMEs: Does diversity matter? Long Range Planning, 52(6), 101913.

Brahma, S., Nwafor, C., & Boateng, A. (2021). Board gender diversity and firm performance: The UK evidence. International Journal of Finance & Economics, 26(4), 5704-5719.

Burgess, Z., & Tharenou, P. (2002). Women board directors: Characteristics of the few. Journal of Business Ethics, 37(1), 39-49.

Burns, J.M. (1978). Leadership. New York: Harper and Row.

Burke, R. J. (1997) Women Directors: Selection, Acceptance and Benefits of Board Membership. Corporate Governance: An International Review, 5, 118-125.

Byoun, S., Chang, K., & Kim, Y. S. (2016). Does corporate board diversity affect corporate payout policy? Asia‐Pacific Journal of Financial Studies, 45(1), 48-101.

Campbell, K., & Mínguez-Vera, A. (2008). Gender Diversity in the Boardroom and Firm Financial Performance. Journal of Business Ethics, 83(3), 435-451.

Carter, D.A., Simkins, B.J., & Simpson, W.G. (2003). Corporate Governance, Board diversity and Firm Value. The Financial review, 38, 33-53.

Carter, D. A., D'Souza, F., Simkins, B. J., & Simpson, W. G. (2010). The gender and ethnic diversity of US boards and board committees and firm financial performance. Corporate Governance: An International Review, 18(5), 396-414.

Coffey, B.S., & Wang, J. (1998). Board Diversity and Managerial Control as Predictors of Corporate Social Performance. Journal of Business Ethics, 17, 1595-1603.

Coles, J. L., Daniel, N. D., & Naveen, L. (2008). Boards: Does one size fit all? Journal of financial economics, 87(2), 329-356.

Colombo, M.G., & Grilli, L. (2010). On growth drivers of high-tech start-ups: Exploring the role of founders’ human capital and venture capital. Journal of Business Venturing, 25(6), 610-626.

Conyon, M. J., & He, L. (2017). Firm performance and boardroom gender diversity: A quantile regression approach. Journal of Business Research, 79, 198-211.

Cook, A., & Glass, C. (2015). Do minority leaders affect corporate practice? Analyzing the effect of leadership composition on governance and product development. Strategic Organization, 13(2), 117-140.

Cox, L. W., Ensley, M. D., & Camp, S. M. (2003). The “Resource Balance Proposition”: Balancing Resource Allocations and Firm Growth. In Issues in Entrepeneurship. Emerald Group Publishing Limited.

Dai, Y., Byun, G., & Ding, F. (2019). The direct and indirect impact of gender diversity in new venture teams on innovation performance. Entrepreneurship Theory and Practice, 43(3), 505-528.

Daily, C. M., Certo, S. T., & Dalton, D. R. (1999). A decade of corporate women: Some progress in the boardroom, none in the executive suite. Strategic management journal, 20(1), 93-100.

Dani, A. C., Picolo, J. D., & Klann, R. C. (2019). Gender influence, social responsibility and governance in performance. RAUSP Management Journal, 54, 154-177.

Delen, D., Kuzey, C., & Uyar, A. (2013). Measuring firm performance using financial ratios: A decision tree approach. Expert systems with applications, 40(10), 3970-3983.

Dwaikat, N., Qubbaj, I. S., & Queiri, A. (2021). Gender diversity on the board of directors and its impact on the Palestinian financial performance of the firm. Cogent Economics & Finance, 9(1), 1948659.

Eagly, A.H., Carli, L.L. (2003). The female leadership advantage: An evaluation of the evidence. Leadership Quarterly, 14(6), 807-834.

Eeckloo, K., Van Herck, G., Van Hulle, C., & Vleugels, A. (2004). From Corporate Governance To Hospital Governance: Authority, transparency and accountability of Belgian non-profit hospitals’ board and management. Health Policy, 68(1), 1-15.

Erhardt, N. L., Werbel, J. D., & Shrader, C. B. (2003). Board of director diversity and firm financial performance. Corporate governance: An international review, 11(2), 102-111.

Erkut, S., Kramer, V. W., & Konrad, A. M. (2008). 18. Critical mass: does the number of women on a corporate board make a difference? Women on corporate boards of directors: International research and practice, 222.

Eulerich, M., Velte, P., & van Uum, C. (2014). The impact of management board diversity on corporate performance. An empirical analysis for the German two-tier system. An Empirical Analysis for the German Two-Tier System (November 8, 2013). Problems and Perspectives in Management (PPM), 12, 25-39.

Eurostat-OECD. (2007). Manual on business demography statistics. Luxembourg: Office for Official Publications of the European Communities.

Fattore, G. (2019). Cost containment and reforms in the Italian National Health Service. In Health care and cost containment in the European Union (pp. 513-546). Routledge.Fernández-Temprano, M. A., & Tejerina-Gaite, F. (2020). Types of director, board diversity and firm performance. Corporate Governance: The International Journal of Business in Society.

Fombrun, C.J. (2006). Corporate governance. Corporate Reputation Review, 8(4), 267-271.

Galletta, S., Mazzù, S., & Naciti, V. (2021). Banks’ business strategy and environmental effectiveness: The monitoring role of the board of directors and the managerial incentives. Business Strategy and the Environment, 30(5), 2656-2670.

García-Meca, E., López-Iturriaga, F. J., & Santana-Martín, D. J. (2022). Board gender diversity and dividend payout: The critical mass and the family ties effect. International Review of Financial Analysis, 79, 101973.Garg, S. (2013). Venture Boards: Distinctive Monitoring and Implications for Firm Performance. Academy of Management Review, 38(1), 90-108.

Golden, B. R., & Zajac, E. J. (2001). When will boards influence strategy? Inclination× power= strategic change. Strategic management journal, 22(12), 1087-1111.

Gomez, L. E., & Bernet, P. (2019). Diversity improves performance and outcomes. Journal of the National Medical Association, 111(4), 383-392.

Goodstein, J., Gautam, K., & Boeker, W. (1994). The effects of board size and diversity on strategic change. Strategic management journal, 15(3), 241-250.Grinstein, Y., & Hribar, P. (2004). CEO compensation and incentives: Evidence from M&A bonuses. Journal of financial economics, 73(1), 119-143.

Gujarati, D. N. (2022). Basic econometrics. Prentice Hall.Henrekson, M. & Johansson, D. (2010). Gazelles as job creators: a survey and interpretation of the evidence. Small Business Economics, 35(2), 227-244.

Hermalin, B., & Weisbach, M. S. (2001). Boards of directors as an endogenously determined institution: A survey of the economic literature. FRB New York - Economic Policy Review, 9, 7-26.

Hillman, A. J. (2015). Board diversity: Beginning to unpeel the onion. Corporate Governance: An International Review, 23(2), 104-107.

Hillman, A. J., Cannella, A. A., & Paetzold, R. L. (2000). The resource dependence role of corporate directors: Strategic adaptation of board composition in response to environmental change. Journal of Management studies, 37(2), 235-256.

Hillman, A. J., Cannella Jr, A. A., & Harris, I. C. (2002). Women and racial minorities in the boardroom: How do directors differ? Journal of management, 28(6), 747-763.

Hillman, A. J., Shropshire, C., & Cannella Jr, A. A. (2007). Organizational predictors of women on corporate boards. Academy of management journal, 50(4), 941-952.Hirschberg, J., & Lye, J. (2001). The interpretation of multiple dummy variable coefficients: an application to industry effects in wage equations. Applied Economics Letters, 8(11), 701-707.

Inostroza, M. A., & Espinosa-Méndez, C. (2022). The influence of the personality traits and sociodemographic CEO characteristics on performance of SMEs: evidence from Chile. Academia Revista Latinoamericana de Administración, 35(4), 435-457.

Isidro, H., & Sobral, M. (2015). The effects of women on corporate boards on firm value, financial performance, and ethical and social compliance. Journal of business ethics, 132, 1-19.

Ismail, K. N. I. K., & Manaf, K. B. A. (2016). Market reactions to the appointment of women to the boards of Malaysian firms. Journal of Multinational Financial Management, 36, 75-88.

Joecks, J., Pull, K., & Vetter, K. (2013). Gender diversity in the boardroom and firm performance: What exactly constitutes a “critical mass”? Journal of business ethics, 118, 61-72.

Julizaerma, M. K., & Sori, Z. M. (2012). Gender diversity in the boardroom and firm performance of Malaysian public listed companies. Procedia-Social and Behavioral Sciences, 65, 1077-1085.

Jurkus, A. F., Park, J. C., & Woodard, L. S. (2011). Women in top management and agency costs. Journal of Business Research, 64(2), 180-186.

Kanter, R. M. (1977a). Men and Women of the Corporation. New York: Basic Books.

Kanter, R. M. (1977b). Some effects of proportions on group life: Skewed sex ratios and responses to token women. American journal of Sociology, 82(5), 965-990.

Kathuria, V., & Dash, S. (1999). Board size and corporate financial performance: an investigation. Vikalpa, 24(3), 11-17.

Kennedy, D., Lakonishok, J., & Shaw, W. H. (1992). Accommodating outliers and nonlinearity in decision models. Journal of Accounting, Auditing & Finance, 7(2), 161-190.

Kimanzi, K., Mwangi, M., Ochieng, D. E., & Lishenga, J. (2020). Moderating effect of board gender diversity on the relationship between financial structure and operating efficiency. Journal of Finance and Investment Analysis, 9(1), 1-14.

Lesch, L., Kerwin, S., Thormann, T. F., & Wicker, P. (2022). Critical Masses and Gender Diversity in Voluntary Sport Leadership: The Role of Economic and Social State-Level Factors. Sustainability, 14(10), 6208.

Li, H., Terjesen, S. & Umans, T. (2020). Corporate governance in entrepreneurial firms: a systematic review and research agenda. Small Business Economics, 54(1), 43-74.

Low, D. C., Roberts, H., & Whiting, R. H. (2015). Board gender diversity and firm performance: Empirical evidence from Hong Kong, South Korea, Malaysia and Singapore. Pacific-Basin Finance Journal, 35, 381-401.

Lückerath-Rovers, M. (2013). Women on boards and firm performance. Journal of Management & Governance, 17, 491-509.

Mahadeo, J., Soobaroyen, T., & Hanuman, V. (2012). Board composition and financial performance: Uncovering the effects of diversity in an emerging economy. Journal of Business Ethics, 105, 375-388.

Marinova, J., Plantenga, J., & Remery, C. (2016). Gender diversity and firm performance: Evidence from Dutch and Danish boardrooms. The International Journal of Human Resource Management, 27(15), 1777-1790.

Matolcsy, Z., & Wyatt, A. (2006). Capitalized intangibles and financial analysts. Accounting & Finance, 46(3), 457-479.

Matsa, D. A., & Miller, A. R. (2013). A female style in corporate leadership? Evidence from quotas. American Economic Journal: Applied Economics, 5(3), 136-169.

Mauro, M., & Giancotti, M. (2021). Italian responses to the COVID-19 emergency: Overthrowing 30 years of health reforms? Health Policy, 125(4), 548-552.

McMahan, G. C., Bell, M. P., & Virick, M. (1998). Strategic human resource management: Employee involvement, diversity, and international issues. Human Resource Management Review, 8(3), 193-214.

Miller, T., & del Carmen Triana, M. (2009). Demographic diversity in the boardroom: Mediators of the board diversity–firm performance relationship. Journal of Management studies, 46(5), 755-786.

Milliken, F. J., & Martins, L. L. (1996). Searching for common threads: Understanding the multiple effects of diversity in organizational groups. Academy of Management Review, 21(2), 402-433.

Moreno-Gómez, J., Lafuente, E., & Vaillant, Y. (2018). Gender diversity in the board, women’s leadership and business performance. Gender in Management: An International Journal, 20(2), 307-323.

Muller‐Kahle, M. I., & Lewellyn, K. B. (2011). Did board configuration matter? The case of US subprime lenders. Corporate Governance: An International Review, 19(5), 405-417.

Naciti, V., Rupo, D., & Pulejo, L. (2021). Gender Diversity and Performance in Family Small-to-Medium Business: Mapping and Clustering Bibliometric Networks. Piccola Impresa/Small Business, (3).

Nielsen, S., & Huse, M. (2010). The contribution of women on boards of directors: Going beyond the surface. Corporate governance: An international review, 18(2), 136-148.

Nurettin Oner, M. S. (2016). Organizational and environmental factors associated with hospital financial performance: A systematic review. Journal of Health Care Finance, 43(2).

Oxelheim, L., & Randøy, T. (2003). The impact of foreign board membership on firm value. Journal of Banking & Finance, 27(12), 2369-2392.

Perryman, A. A., Fernando, G. D., & Tripathy, A. (2016). Do gender differences persist? An examination of gender diversity on firm performance, risk, and executive compensation. Journal of Business Research, 69(2), 579-586.

Post, C., & Byron, K. (2015). Women on boards and firm financial performance: A meta-analysis. Academy of management Journal, 58(5), 1546-1571.

Rasmussen, C. C., Ladegård, G., & Korhonen‐Sande, S. (2018). Growth intentions and board composition in high‐growth firms. Journal of Small Business Management, 56(4), 601-617.

Rose, C. (2007). Does female board representation influence firm performance? The Danish evidence. Corporate Governance: An International Review, 15(2), 404- 413.

Ruigrok, W., Peck, S., & Van Der Linde, C. (1999). Strange bedfellows: Foreigners on top management teams and boards. Working paper, Research Institute for International Management, University of St. Gallen, Switzerland.

Ruigrok, W., Owtscharov, A. and Greve, P. M. (2005). On the Stickiness of Local Roots: Trajectories of Top Management Team and Board Internationalisation in Four European Countries. Working paper, Research Institute for International Management, University of St. Gallen, Switzerland.

Salloum, C., Jabbour, G., & Mercier‐Suissa, C. (2019). Democracy across gender diversity and ethnicity of Middle Eastern SMEs: how does performance differ? Journal of Small Business Management, 57(1), 255-267.

Satriyo, H., & Harymawan, I. (2018). The role of female CEOs on firm performance: Some evidence from Indonesian listed firms. In Proceedings of the Journal of Contemporary Accounting and Economics Symposium 2018 on Special Session for Indonesian Study (JCAE 2018)-Contemporary Accounting Studies in Indonesia (pp. 309-315).

Schein, V. E. (1973). The relationship between sex-role stereotypes and requisite management characteristics. Journal of applied psychology, 57(2), 95.

Schein, V. E., Mueller, R., Lituchy, T., & Liu, J. (1996). Think manager—think male: A global phenomenon? Journal of organizational behavior, 17(1), 33-41.

Shehata, N., Salhin, A., & El-Helaly, M. (2017). Board diversity and firm performance: evidence from the UK SMEs. Applied Economics, 49(48), 4817-4832.

Singh, J., Singhania, S. & Aggrawal, D. (2023). Does board gender diversity impact financial performance? Evidence from the Indian IT sector. Society and Business Review, 18(1), 51-70.

Simionescu, L. N., Gherghina, Ş. C., Tawil, H., & Sheikha, Z. (2021). Does board gender diversity affect firm performance? Empirical evidence from Standard & Poor’s 500 Information Technology Sector. Financial Innovation, 7(1), 1-45.

Shrader, C. B., Blackburn, V. B., & Iles, P. (1997). Women in management and firm financial performance: An exploratory study. Journal of managerial issues, 355-372.

Shrader, R., & Siegel, D. S. (2007). Assessing the relationship between human capital and firm performance: Evidence from technology–based new ventures. Entrepreneurship theory and Practice, 31(6), 893-908.

Schippers, M.C., Hartog, D., Koopman, P.L., & Wienk, J.A. (2003). Diversity and team outcomes: the moderating effects of outcome interdependence and group longevity and the mediating effect of reflexivity. Journal of Organizational Behaviour, 24, 779-802.

Siciliano, J.I. (1996). The relationship of board member diversity to organizational performance. Journal of Business Ethics, 15, 1313-1320.

Simpson, W. G., Carter, D., & D'Souza, F. P. (2010). What do we know about women on boards? Journal of Applied Finance (Formerly Financial Practice and Education), 20(2).

Smith, N., Smith, V., & Verner, M. (2006). Do women in top management affect firm performance? A panel study of 2,500 Danish firms. International Journal of productivity and Performance management, 55(7), 569-593.

Sterk, V., Sedláček, P., & Pugsley, B. (2021). The nature of firm growth. American Economic Review, 111(2), 547-79.

Styhre, A., & Eriksson‐Zetterquist, U. (2008). Thinking the multiple in gender and diversity studies: Examining the concept of intersectionality. Gender in Management: An International Journal, 23(8), 567-582.

Tartaglia Polcini, P., Aversano, N., Nicolò, G., & Ardito, N. (2021). La diversità di genere nella direzione strategica delle aziende sanitarie: il rapporto tra governance e performance nelle aziende ospedaliere italiane. Mecosan, 120(4), 21-43.

Taylor, M. (2000). Ruling delivers good, bad news. Modern Healthcare, 30(22), 6-6.

Terjesen, S., Sealy, R., & Singh, V. (2009). Women directors on corporate boards: A review and research agenda. Corporate governance: an international review, 17(3), 320-337.

Torchia, M., Calabrò, A., Huse, M., & Brogi, M. (2010). Critical mass theory and women directors' contribution to board strategic tasks. Corporate Board: Role, Duties & Composition, 6(3).

Vecchi, V., Tanese, A., & Osborne, S. (2022). Do public-private partnerships still have a future? Public Works Management & Policy, 27(4), 337-341.

Watson, W. E., Kumar, K. & Michaelsen, L. K. (1993). Cultural diversity’s impact on interaction process and performance: Comparing homogenous and diverse task groups. Academy of Management Journal, 36(3), 590-602.

Westphal, J.D., & Zajac, E.J. (1995). Who shall govern? CEO/board power, demographic similarity, and new director selection. Administrative Science Quarterly, 40(1), 60-83.

Wu, J., Richard, O. C., Triana, M. D. C., & Zhang, X. (2022). The performance impact of gender diversity in the top management team and board of directors: A multiteam systems approach. Human Resource Management, 61(2), 157-180.

Zahra, S. A., & Stanton, W. W. (1988). The implications of board of directors composition for corporate strategy and performance. International journal of management, 5(2), 229-236.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright (c) 2023 Marianna Mauro, Monica Giancotti, Elisa Rita Ferrari, Giulia Cattafi