The effects of private equity investors on the governance of firms

Companies that receive external equity typically experience a separation of ownership and control, where owners who are not involved in the company (principals) have to rely on the management team (agents) for achieving expected goals and target levels. Theoretical literature argues that when ownership and control are separated, principals develop governance structures to reduce agency costs and align agents’ incentives (Berle and Means, 1932; Jensen and Meckling, 1976; Grossman and Hart, 1986; Zingales, 1995). Likewise, optimal financial structure design by financial intermediaries can effectively help to mitigate agency problems by identifying self-enforcing equilibria (Diamond, 1984; Fama and Jensen, 1985; Stiglitz, 1985; Bhattacharya and Thakor, 1993; Barry, 1994). In general terms, governance and financial devices can be thought of as either internal control mechanisms (such as the board) or external control mechanisms (such as the market for corporate control). An increasingly important external control mechanism affecting the governance of young and fast-growing companies worldwide is the emergence of institutional and private equity investors, as equity owners. Institutional investors have the potential to influence management’s activities directly through their ownership, and indirectly by trading their shares (Gillan and Starks, 2003). In this respect private equity investors are differentiated from institutional ones in the longer-term view and in the significantly more hands-on approach that they pursue when investing in a portfolio company. As a result, companies backed by private equity investors represent a fruitful environment to investigate the use and efficiency of a multitude of control mechanisms. The surge over the last 30 years in investment activity by private equity investors at large has given rise to an increased specialization of this class of investors conditional on the risk return profiles associated with different investment and firm life cycle stages. For instance, business angels supporting the archetypical ‘paper company’ start-up face a risk exposure that in terms of both magnitude and characteristics is significantly different from that incurred by a private equity investor acquiring control of a mature company. Yet, investors in this market share common traits such as a value maximization approach, risk‒return informed decisions, and a deep knowledge of governance mechanisms. As such their influence on portfolio company governance mechanisms is largely similar in terms of depth and breadth. In this chapter we aim at presenting an up-to-date review of the main theoretical contributions and empirical results in this active and growing field of research

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

On value and value creation: Perspectives from board research and practice in SMEs

This is a draft chapter. The final version is available in Research Handbook on Boards of Directors edited by Jonas Gabrielsson, Wafa Khlif and Sibel Yamak, 2019, Edward Elgar Publishing Ltd. https://doi.org/10.4337/9781786439758.00035 The material cannot be used for any other purpose without further permission of the publisher, and is for private use only.While corporate governance research has been evolving over the last decade, it still has challenges to deal with. In this chapter we will discuss the contributions of the board of directors to value and value creation. This study reveals that, independent of the context of the board, there will be various definitions and perceptions about value and consequently on value creation in firms. In addition to a literature review of recent research on the governance of SMEs with a focus on value and value creation, results from interviews with board directors on SME boards are presented and reveal what directors perceive to be value and what they aim to do to create value. While research supports the practitioners’ perspective on value and value creation, there seems to be a disproportionate focus on financial performance and the structural aspects of boards in corporate governance research, which is not supported by the practitioners’ perspective