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Abstract

On the basis of agency and resource dependence theories, this paper mainly discusses the relationship between the board and financial performance of nonprofit foundations (NPFs) in China. The data used in this study were obtained from the 2017 annual work report of 203 national public and private fundraising NPFs. Conclusions of this empirical research are as follows. Board size is positively correlated with organizational performance. The size of the supervisory board is positively associated with total and donation incomes. In public NPFs, a negative relationship exists between the average age of directors and total and donation incomes. Foundations with fewer government officials among their directors have a higher total income. In public fundraising NPFs, a positive relationship exists between the proportion of paid directors and total and donation incomes, whereas no correlation is observed in private fundraising NPFs. This study has significant implications for understanding the relationship between board composition and organizational performance among NPFs in China. This study focuses on the effective features of boards in NPFs to enhance competitiveness in access to public resources after the enactment of the Charity Law.

Plain language summary

The article mainly discusses the relationship between the board and financial performance of nonprofit foundations (NPFs) in China. Using the data from the 2017 annual work report of 203 national public and private fundraising NPFs, this study measured organizational financial performance adopting the definition from Ritchie and Kolodinsky (2003) and choose 12 independent variables to represent board characteristics. Empirical research has indicated a correlation between some characteristics of the board of directors and organizational performance. Board size is positively correlated with organizational performance. The size of the supervisory board is positively associated with total and donation incomes. The average age of directors is negatively correlated with total income in public NPFs and with the donation income in all NPFs. In foundations with fewer government officials among all directors, they perform better in terms of total income. In public fundraising NPFs, the proportion of directors who receive remuneration is positively correlated with the total and donation incomes, whereas in private fundraising NPFs, they show no correlation. This study has several limitations that should be noted. The measurements of board characteristics and effectiveness did not cover all elements of nonprofit board and organizational effectiveness mentioned in the literature due to data unavailability. Another limitation is that the cross-sectional data could not establish the causal relationship between governance structure and organizational performance. For future research on performance of NPFs in China, scholars need to pay special attention to the changes in China’s charitable legal environment, which is an important background in this study.

Keywords

nonprofit foundation organizational performance financial performance board China

Introduction

Nonprofit foundations (NPFs) existing as an important category of nonprofit organizations (NPOs) are now constant partners of social governance. NPFs have greatly promoted local charity and community development in various countries around the world (Brown, 2005; Olson, 2000). Given the importance of NPFs in social governance, scholars have been increasingly paying attention on how performance can be improved to ultimately realize organizational goals (Bellante et al., 2018; Callen et al., 2010; Jackson & Holland, 1998; Lee, 2021) and resolve social problems. As the decision-making and supervisory body of NPFs, the board has been endowed with extremely important functions in management science (Yan, 2012). A series of studies on board functions have emphasized financial functions, such as financial supervision and resource mobilization (Chien et al., 2009; Green & Griesinger, 1996; Iecovich, 2004; Inglis et al., 1999). Research on the factors influencing the financial performance of NPFs has mainly focused on the effects of board characteristics on financial performance (Brown, 2005; Iecovich, 2004; Li & Xie, 2019; Tian & Zhou, 2013; Yan & Xue, 2013; Zhang & Li, 2013). Studies have shown that a certain correlation may exist between board size and financial performance (Aggarwal et al., 2012; Olson, 2000; Yan, 2012), whereas a few studies have indicated that the correlation between the board size and financial performance of NPFs is insignificant (Brown, 2005) or even negative (Callen et al., 2003). Other scholars have discussed the relationship between financial performance and fundraising ability (Yan & Chen, 2011), income type (Daniel & Kim, 2018), internal governance, and external environment (Qian, 2020).

In China, NPFs have experienced rapid development for almost three decades. This progress was particularly noticeable post-2008 that marked a monumental year for philanthropy in China. Charitable donations crossed a major milestone of 100 billion yuan, primarily as a response to the Sichuan Province earthquake. In addition, the year 2008 marked the rise of volunteerism, significantly triggered by the Beijing Olympics. The subsequent years saw an unprecedented increase in their count, which amplified by 400% in 2020 compared with 2008. Their active participation and invaluable contributions in community philanthropy have considerably benefitted Chinese society and its people. This growth of NPFs parallels China’s historical journey of economic reform and social structural changes (Qian, 2020; Yan, 2012). The fourth Plenary Session of the Central Committee of the 19th Communist Party of China proposed to improve the party’s leadership system of NPOs while emphasizing the role of NPFs, thereby realizing the positive interaction among government’s governance, social adjustment, and residents’ autonomy. In the context of the new era, in which the Chinese government attaches great importance to social governance innovation and functional transformation, NPFs have to improve organizational performance to effectively play their role in social governance (L. L. Liu et al., 2020; Zhang & Li, 2013). The recent surge in the urgent need to improve NPFs’ organizational performance is not only due to the importance they hold but also due to the new legal environment that has evolved. The Charity Law of the People’s Republic of China, enacted on September 1, 2016, set legal parameters around NPF fundraising activities, thereby enhancing the competition between public and private fundraising NPFs in obtaining public resources. Due to this law, public fundraising qualifications are universally accessible to all types of charitable organization, leading to escalated competitiveness for resources. However, the situation was contrasting prior to the Charity Law’s enactment, where only public foundations had access to public fundraising qualification. This phenomenon illustrates how lawmaking has broadened the competitive arena for NPFs to secure donation resources.

Under the new background of the Charity Law, how can NPFs effectively obtain more resources in the fierce competition? This changing context demands considerable enhancements organizational performance. This study focuses on the relationship between the board of directors, as well as of supervisors and organizational performance of NPFs in China. Empirical evidence shows that the board of directors and supervisors has a close relationship with organizational performance. Agency theory also provides a reliable theoretical basis for the study of the relationship between the board and organizational performance. This study attempts to answer the question: Is the board of directors and supervisors related to organizational performance? This research question is analyzed through the empirical data of NPFs in China nationally, which are registered with the Ministry of Civil Affairs of the People’s Republic of China. Scholars have come to many interesting conclusions about the relationship between the board and organizational performance, providing a wealth of informative and inspiring conclusions. However, the relationship between the same two variables presents different conclusions. These differences indicate the conditional differences of the relationship between board variables and organizational performance variables. Research on China’s NPFs has mainly focused on public fundraising NPFs due to the introduction of the Charity Law only in 2016. Before this, the difference between public and private fundraising NPFs was distinct. This paper mainly discusses the relationship between the board structure and financial performance of NPFs, using updated data and including public and private fundraising NPFs under the new background of the Charity Law in China.

Literature Review

Core Elements of Organizational Performance

In the field of nonprofit research, performance has consistently been a significant focus (Yusif, 2015), mainly due to the commitment it reflects toward donors. Organizational performance has multiple dimensions and is assessed differently across various contexts (Callen et al., 2010).

Financial Performance

One of the key objectives of financial performance is efficient collection and management of resources (Martínez & Guzmán, 2017). In this sense, NPF scholars have measured organizational performance as the ability in collecting resources and using financial indicators (i.e., total revenues; Bellante et al., 2018). Ritchie and Kolodinsk (2003) divided the financial indicators of NPOs into four aspects: financial performance, financing efficiency, public support, and investment performance. After factor analysis, the financial indicators are finally defined as financing efficiency, financial performance, and public support. Brown (2005) revised the above indicators into four indicators: financial performance, public support, financing efficiency, and net income. In Olson’s (2000) research, total revenue, and gift income were used to measure performance. In Jackson and Holland’s (1998) research, financial performance was the main focus, measured by total revenue, annual operating budget, and financial reserves. From the agency theory perspective, the purpose of agency behavior is to maximize the interests of the principals. Therefore, performance measurement is required by the principals and agents. Revenue is undoubtedly an important indicator of organizational financial performance, viewed as a direct output of fundraising activities. The promotion of organizational performance can help obtain more donation resources (Lee, 2021). From the perspective of resource dependence, performance measurement is adopted as a strategy to respond to the accountability of resource providers and increase opportunities to access other resources (Lee, 2021). Revenue analysis offers resource providers a clear understanding of organizations’ dependence on various financial resources.

NFP

In addition to financial criteria, Iwu et al. (2015) found that the effectiveness of NPOs is also based on nonfinancial criteria. They also claimed that the effectiveness of NPOs should be viewed in two ways: “the full achievement of its mandate” and “the ability to run business projects to cover the cost.”

Agency theory underlines a specific type of relationship that emerges when one party delegates responsibilities to another. The two subjects are referred to as principals and agents. Agents are obliged to act in accordance with the principal’s intentions (Lacruz et al., 2019). Due to information asymmetry, principals cannot always be completely aware of the agents’ actions. Therefore, they resort to assessing agents’ behaviors based on objective indicators, such as performance from the agency theory perspective (Lee, 2021). One needs to then question, what are the benefits the principals aim to secure? Fundamentally, the effective operation of foundations to achieve their objectives is paramount. Thus, obtaining a certain amount of revenue is a prerequisite.

Given the intrinsic scarcity of resources, resource dependence theory advocates for organizations to always sustain their resource accessibility for continued development in a competitive environment (Lee, 2021). For NPOs, funding is considered a key resource (Grønbjerg 1993; Hodge & Piccolo, 2005). Thus, in this study, revenues derived from three main sources (i.e., total, donations, and investment incomes) serve as indictors to measure the capacity for mobilizing resources that represent financial performance.

Therefore, although there exists a strong heterogeneity of NPFs’ performance indicators, revenue is an important, reasonable, and undeniable variable from theoretical and empirical research perspectives. Therefore, the authors consider revenues to be a good measure of NPF performance in this study.

Core Elements of Board and Its Relation With Organizational Performance

The survival of NPOs is intrinsically tied to their boards as they can significantly affect organizational performance (Herman & Renz, 2000). In the nonprofit sector, the board is the core element of governance (Minciullo & Pedrini, 2020), taking on a pivotal role in decision making.

Board Size and Structure

Board size and structure are often chosen as important variables in governance. Increasing the board size positively affects the organizational performance and has a significantly positive influence on the ability of the charity to collect resources (total revenues; Bellante et al., 2018). Revenue increases with the board size (Olson, 2000). O’Regan and Oster’s (2005) research indicated that differences in individual-level monitoring and financial contributions correlate with board size and independence. In organizations with a large board size, the total amount of donations will increase, whereas the supervision of individual board directors concurrently become diluted. Bellante et al. (2018) analyzed the relationship between board characteristics and performance among a sample of 200 UK NPOs, exploring their ability to collect financial resources. A strong positive relationship was observed between organizational financial performance and board size. Other research has also confirmed a positive correlation between board size and financial performance (Aggarwal et al., 2012; Olson, 2000). Zhang and Li (2013) found that the size of the board of directors is positively correlated with financial performance, whereas the size of the board of supervisors is not significantly correlated with financial performance.

Gender Diversity

Research by Buse et al. (2016) indicated that gender diversity is absolutely important for efficient governance and decision-making process. The ratio of women board members also affects financial performance, with boards hosting a larger number of women often showing superior financial management (Ward & Forker, 2017).

Hinnal and Monteduro (2017) discussed the relationship between board skills and organizational outcomes. They did not consider diversity as a relevant factor, and instead focused on individual skills and professional background of board members, which they regarded as more important to foundations. Buse et al. (2016) investigated how diversity policies, practices, and inclusive behaviors of the board serve as mediating variables between factors such as age, gender, race, and governance performance. Their findings suggested an improvement in performance with a highly diverse board, a situation that manifests when the board operates inclusively, and when policies and practices allow diverse members to actively contribute.

Other Characteristics

Van Puyvelde et al. (2018) indicated that organizational effectiveness is related with various board characteristics, such as leadership attributes, meeting protocols, and group dynamics within several governance roles and responsibilities. Bellante et al. (2018) found that reductions in information asymmetry between a nonprofit’s management, its board, and stakeholders can produce a high level of accountability, thereby increasing organizational performance. In addition, H. Li (2019) explained how the interplay between contextual and strategic factors affect post-succession performance. Succession context and strategic orientations influence post-succession performance.

However, some scholars have indicated that board size, the number of committees, and the proportion of donors in the board of NPOs are not significantly related to organizational performance (Bradshaw et al., 1992; Brown, 2005; Callen & Falk, 1993). For NPOs, some scholars have suggested that establishing a completely consistent perspective on the relationship between board structure and overall performance is improbable due to the difficulty in measuring performance (O’Regan & Oster, 2005). Bradshaw et al. (2006) found that board size and composition can rarely explain differences in organizational effectiveness. The optimal distribution of foundation resources is considerably influenced by the diversity of expertise and proactive involvement among the board members. Forbes and Milliken (1999) asserted that board independence may not always constitute a positive aspect, echoing the findings of O’Regan and Oster. The diversity of knowledge and active participation in decision making can significantly elucidate the efficiency of the foundation (De Andrés-Alonso et al., 2010). Martínez and Guzmán (2017) also found a negative relationship between board size and organizational efficiency. When risks outweigh benefits brought by a large board size, it can lead to a decrease in organizational performance.

L. L. Liu (2015) studied the relationship between internal governance characteristics and fund performance. The results showed that the characteristics of the board of directors and the board of supervisors affect the financial performance of NPFs. Zhang and Li (2013) discussed the relationship between the size of the board of directors, the size of the board of supervisors, the political contacts of the directors, and the number of meetings of the board of directors and foundation performance, taking national NPFs as samples. H. P. Liu et al. (2016) found that board size, average age, and proportion of women significantly affect the fundraising ability of NPFs. Moreover, the proportion of women on the board significantly affect the public support of NPFs. The board size and the average attendance rate of the meeting significantly affect the evaluation level, whereas other variables in the governance structure of the board does not affect organizational performance.

To synthesize existing research, numerous internal governance variables, which are mainly related to decision-making mechanism (e.g., stability of the NPOs’ environment, board structure and composition, board size and independence, board behavior, board diversity, board policies and practices, board meeting practices, board group dynamics, administrative expense ratio, individual director, interpersonal attraction, and cognitive conflict) are considered.

The literature review indicates that differences exist in research conclusions about the relationship between the board and organizational performance in NPFs. The three reasons for the difference are the definition of organizational performance; the methods used in data processing; and the differences in the country, region, type, and data year of the research object, which give rise to different empirical conclusions for the variable relationship. Several striking similarities can also be found in the studies. They consistently choose similar theoretical frameworks, mainly relying on agency theory and resource dependence theory. The chosen independent variables are also mostly centered around the board size and structure.

Theoretical Background and Hypotheses

Theoretical Framework

Most of empirical studies on the governance of NPFs have focused on the relationship between the board and organizational performance, given that the board of an organization has the legal responsibility of performing governance functions (Cornforth, 2012). Similar to the corporate world, boards are expected to monitor management and engage in various operational tasks, such as fundraising (O’Regan & Oster, 2005). Scholars have sought to address which board characteristics are most likely to influence the boards’ ability to promote performance (Bellante et al., 2018).

Agency theory has been extensively used in explaining the relationship between the board and organizational performance (Lacruz et al., 2019). It has consistently been used in analyzing the subject relationship in enterprise management. It advocates the separation of ownership and management rights. In scenarios where ownership remains constant, the property owner delegates management rights to another party. It is a new corporate governance model that emerged once the corporate system advanced to a certain level and scale. The primary objective of agency theory is to determine how principals construct the optimal contract to motivate agents in an environment of conflicting interests and information asymmetry. Therefore, a board is successful when it keeps administrative expenses to a minimum by cutting unnecessary administrative expenses and optimizing supervision from the agency theory perspective (Callen et al., 2010). According to agency theory, the size and composition of the board of directors affect the supervision and incentive behavior of the board of NPOs, which, in turn, affect the management’s behavior and the financial performance of the organizations. The relationship of dual agency within NPFs can be analyzed using agency theory. Operating as an agent, with investors or legal persons as clients, the board also fills the role of a client, with executors acting as agents. The behavior of the board is likely to be related to the performance of the organization in its pursuit to fulfill clients’ desires and improve organizational performance. Hillman and Dalziel (2003) reported that agency theory is often used to explain the connection between the board of NPOs and organizational performance. On the basis of the assumption that the board and managers are in opposition, this theory holds that the board is responsible for supervising managers’ self-interested behaviors. A close relationship exists between strict supervision and management behavior and the improvement of organizational performance. Performance-related board characteristics should also be analyzed. A crucial aspect of NPO performance is the efficiency of managing funds.

Resource dependence theory focuses on raising resources. It has good applicability to explain the construction of the nonprofit board. NPOs rely heavily on the external environment. Resource dependence encompasses the concept of resource scarcity, highlighting the strategies used by organizations or individuals to acquire resources in environments where these resources are limited, and assessing the subsequent effects on their independence. Organizations with a strong capacity to acquire and maintain resources are more likely to survive (Lee, 2021). The monetary capital, human resources, material resources, and other elements depend on the offer of the society, and the board structure is a resource-acquisition mechanism. For the survival of organizations, they need to draw resources from the surrounding environment and depend on and interact with the surrounding environment to achieve the purpose. From the perspective of resource dependence theory, an essential measure for assessing a board’s performance is its effectiveness in augmenting the organization’s capability to secure resources (Callen et al., 2010). Organizations with a large number of board members have been associated with superior performance (Siciliano, 1996). In China’s political and legal environment, political ties and external resources are important resources for NPFs. In contrast to research on NGOs in Western countries, the unique sociopolitical relationships in NGO studies in China must be considered, as it adopts an authoritarian political system (Qian, 2020). Political connections are crucial for NGOs, and such resources hold the greatest importance for the survival and development of these organizations (Hsu, 2010). However, Qian (2020) found that a foundation’s ability to access resources is not affected by political connections. Despite different results, identity and social relationship are the necessary conditions for obtaining political contacts and external resources. Therefore, board characteristics related to resource acquisition can be identified. Callen et al. (2010) found that agency theory and resource dependence theory are complementary and provide different perspectives on the performance of NPOs. However, resource dependency theory offers a more convincing explanation for statistical differences compared with agency theory.

This paper is based on the hypothesis that the board characteristics of NPFs influence financial performance. On this basis, using variables from agency theory and resource dependence theory, this paper analyzes the influence of the board on organizational performance from the perspectives of board size, political connections, gender, and age of directors, as shown in Figure 1.

Figure 1.

Theoretical framework.

In the internal governance of NPOs, the board plays a vital role in improving organizational performance, as it is at the center of dual agency. In the previous literature review, many empirical conclusions are about the significantly positive correlation between the board of directors and organizational performance. Therefore, according to agency theory, the basic hypothesis of this study is formed around the ideology that board characteristics affect organizational performance. Scholars have fully acknowledged the role of agency theory and resource dependence theory in board research. Although agency theory might provide a more fitting framework to explain the board’s role, resource dependence theory is better at elucidating the board’s behaviors (Hillman et al., 2009). Resource dependence theory interprets the efforts of organizations in acquiring resources and delves into their influence on the organization’s survival, performance, and development (Callen et al., 2010). Therefore, when operationalizing the board characteristics, the authors choose indicators, such as size, age of directors, gender of directors, and political connection of directors according to resource dependence theory.

Hypotheses

Researchers have mixed opinions on the influence of board size on the financial performance of NPFs. Most scholars have indicated that board size has a strongly positive relationship with NPOs’ financial performance (Bellante et al., 2018; Brown, 2005). Moreover, a smaller board is more conducive to improving financial performance (Yermack, 1996). From the resource dependence perspective, a large board size is likely to ensure greater access to external resources (Guo, 2007), including financial, human, and relationship resources. A larger board has a greater ability to cross borders and draw resources from the environment, and expanding the board can provide more information and resources for NPOs (Yan & Xue, 2013). Consequently, the following hypothesis is proposed:

H1: Board size has a positive relationship with organizational financial performance.

Research on the relationship between the number of board meetings and financial performance is relatively rare (Zhang & Li, 2013). Existing research shows two perspectives. The mainstream empirical view holds that the two are not related (Brown, 2005; Callen et al., 2010; Yan, 2012), whereas another viewpoint holds that the two are positively correlated (Olson, 2000; Zhang & Li, 2013). Olson (2000) believed that the more meetings the board of directors have, the more supervisory responsibilities will be performed, and organizational performance will likely be improved. Callen et al, (2010) proved that the number of meetings is not correlated with the ratio of management, fundraising, and project expenses of NPOs. Brown (2005) proved that given the lack of formal agenda setting, the number of meetings is not significantly correlated with organizational financial performance. At present, a serious formalization phenomenon in the NPFs’ board meeting in China leads to the fact that the board meeting does not really play its due role. L. L. Liu (2015) concluded that the number of board meetings of Chinese foundations is not correlated with organizational performance while Zhang and Li (2013) suggested the two are positively correlated. In China, decision-making mechanism of NPFs heavily relies on meetings which are a way for the board of directors to fulfill their agency responsibilities. The effectiveness of their performance lies both in the number and the quality of the meetings. Therefore, the following hypothesis is proposed:

H2: The number of board meetings is positively correlated with the financial performance of NPFs.

From the agency theory perspective, the board, representing the client's interests (Vitolla et al., 2020), holds the primary responsibility for supporting and monitoring managerial decisions (Minciullo & Pedrini, 2020). Information asymmetry may make the director’s agency behavior deviate from the client’s will. Therefore, complete and normative NPFs’ structure requires the establishment of the board of supervisors and mainly plays the role of internal supervision. The larger the size of the board of supervisors is, the greater the supervisory role will be, and the better the principal–agent problem can be controlled, thereby making the foundation achieve higher performance (Zhang & Li, 2013). Internal supervision can effectively prevent the occurrence of this risk. By supervising the behavior of the board of directors, the board of supervisors can promote the improvement of organizational performance. Therefore, the following is hypothesized:

H3: Effectively supervising the board of supervisors increases the financial performance of NPFs.

The age of directors has a significantly negative effect on fundraising ability and financial performance. The higher the proportion of directors over 60 years old in the board of directors is, the worse the fundraising ability and financial performance of NPOs will be (Yan & Xue, 2013). Under the current environment in China, influential NPOs are basically established in a top–down manner. The competent authority has a strong control over NPOs, and the leadership of directors and the board of directors are often regarded as a way of transition or placement for the leaders of the competent authority to step back. The autonomy and independence of nominating and selecting directors of NPOs are strictly limited, so the directors are generally older, and the functions of the board of directors are also affected. Thus, the following hypothesis is proposed:

H4: The average age of directors is negatively associated with organizational financial performance.

Gender diversity has become a frequently considered indicator of organizational performance. Notably, a high proportion of female directors is observed in NPOs’ boards (Ward & Forker 2017). Reddy et al. (2013), Bradshaw et al. (1992), and Hillman et al. (2002) indicated a close relationship between the proportion of women board of directors and financial performance. Women’s likeability and ability to harmonize board relationships can help organizations improve financial performance. Therefore, this study hypothesizes the following:

H5: The gender composition of board members is associated with organizational performance. Concretely, more female board members have a positive influence on organizational performance.

In research on NPOs in China, political factors are often regarded as important background or core variables (L. L. Liu, 2015; Luo et al., 2012; Qian, 2020; Yan & Xue, 2013) due to their considerable effect on NPO practices within China’s authoritarian political system. Chinese NPFs’ political connections frequently involve government officials within the organization, especially those with provincial or ministerial level experience or higher. These political connections are regarded as guanxi in Chinese society (Qian, 2020), which can be loosely translated as “relations,”“connections,”“social networks,”“social capital,” or even “reciprocal obligations” (Luo et al., 2012). Guanxi represents an important resource, especially when retired government officials assume leadership roles at NPOs. NPOs often rely on political guanxi to mobilize social resources and raise substantial funds. The political connections of the board of directors can improve the fundraising ability and financial performance of NPOs (Yan & Xue, 2013). NPFs with more political connections, especially those with current and/or retired government officials on their boards, are likely to generate higher revenues (Qian, 2020). Thus, this study hypothesizes:

H6: The political connections of the board positively affect the financial performance of NPFs.

Given the special nature of NPFs, the effect of money as an incentive means in NPOs is limited. In order to make up for the contributions of the directors within a certain range, NPFs will also pay compensation to a few directors. The Regulations on the Administration of Foundations in China indicates that “the number of directors who receive remuneration from foundations shall not exceed one-third of the total number of directors,” and “the salary, welfare, and administrative expenses of the staff of foundations shall not exceed 10% of the total expenses of the year.” Under such salary expenditure restrictions, there needs to be sufficient reasons for who to pay and how much to pay. Therefore, it can be argued that within one-third of the range, the higher the proportion of directors receiving compensation, the greater the incentive effect on directors. On the basis of legal constraints and incentives for directors, the following hypothesis is proposed:

H7: The proportion of directors receiving remuneration is positively correlated with the financial performance of NPFs.

Methods

Data Source

The Charity Law was enacted is 2016. Thus, this study collected data in 2017 to explore the internal governance of NPFs on their financial performance. In 2017, 213 NPFs were registered with the Ministry of Civil Affairs of China. These foundations needed to submit an annual work report to the Ministry of Civil Affairs of China every year, and these annual work reports are available from the website of the Public Service Platform of China Social Organization (https://www.chinanpo.gov.cn/ndbgsindex.html). The data used throughout this study were obtained from the 2017 annual work report of 203 national public and private fundraising NPFs. Ten foundations lacked values of several independent variables for this study, so they were not included for the analysis. Thus, 203 national public and private fundraising NPFs are valid samples in this study. The authors extracted the information of dependent and independent variables for analysis. The secondary analysis of data from the annual work report of 203 NPFs did not require ethical approval.

Dependent Variables

Regarding the measurement of organizational financial performance, this study adopted the definition from Ritchie and Kolodinsky (2003). Specifically, financial performance was measured by three indicators, namely, the natural logarithm of total income in the fiscal year of 2017 (ln_total income), the natural logarithm of donation income in the same year (ln_donation income), and the natural logarithm of investment income in the same year (ln_investment income). Here, total income was the net income, donation income was all donation incomes, and investment income was from all sources.

Independent Variables

The independent variables considered in this study were the size of the board of directors (measured as the number of directors in the NPFs), the proportion of directors receiving remuneration, the proportion of female directors among all directors, the average age of directors, the number of board meetings, the proportion of government officials among all directors, the proportion of directors who have served as provincial- and ministerial-level leaders among all directors, the size of the supervisory board, the proportion of female supervisors in all supervisors, the average age of supervisors, net assets, and type of NPFs. Among these 12 variables, the former 11 variables were continuous variables. Regarding the type of NPFs, it was a nominal variable (public NPF = 1, private NPF = 0). In view of a salient difference between public and private NPFs in raising funds, the type of NPFs was considered when predicting.

Data Analysis

Descriptive statistics were used to understand the basic information of the dependent and independent variables. Multiple linear regression models were then developed to test the effect of the board composition on the NPFs’ financial performance in China. All dependent variables in this study exhibited a normal distribution. Thus, the ordinary least squares model was appropriate for data analysis. In addition, subgroup analysis was conducted to estimate the public–private nonprofit difference in financial performance. All predicting variables were simultaneously included in the model. The regression model was assessed with the statistical package SPSS 24.0. No evidence of multiple collinearity among the independent variables was found in this study (all VIF < 2).

Results

Table 1 reports the descriptive results of the dependent and independent variables. On average, the total income of the 203 NPFs was RMB 262,390,287.4 (roughly US$ 37,076,520, SD = 1,608,696,014) in 2017, the donation income was RMB 229,367,437.91 (roughly US$ 32,437,307, SD = 1,594,063,141.54), and the investment income was RMB 813,997,481.47 (roughly US$ 115,116,104, SD = 3,483,384,292.53). The net asset was RMB 294,656,982.39 (roughly US$ 46,585,269, SD = 970,573,469.52). The average size of the board of directors was 12.95 directors (SD = 5.83). Among the foundations, the proportion of directors receiving remuneration was 6.7% (SD = 0.1511) on average. The average age of directors was 56.35 years old (SD = 5.70). Each foundation had 2.40 (SD = 1.15) board meetings on average. The average proportion of female directors among all directors was 19.05% (SD = 0.1511). The average percentage of government officials among all directors was 2.55% (SD = 0.1066). The proportion of directors who have served as provincial- and ministerial-level leaders among all directors was 7.59% (SD = 0.1671) on average. The average number of supervisors in the supervisory board was 1.94 (SD = 1.32). Female supervisors accounted for 30.89% (SD = 0.4039) on average among all supervisors. The average age of supervisors was 54.73 (SD = 9.09). Among the 203 foundations, 115 (56.7%) were private fundraising NPFs.

Table 1.

Descriptive Statistics of the Dependent and Independent Variables (n = 203).

Variables	Mean or percent	SD	Minimum	Maximum
Total income (RMB)	262,390,287.4	1,608,696,014	50,405.24	21,828,084,313.61
Donation income (RMB)	229,367,437.91	1,594,063,141.54	0.00	21,805,400,463.75
Investment income (RMB)	813,997,481.47	3,483,384,292.53	−320,516,263.00	31,465,909,936.00
Size of the board of directors	12.95	5.83	5	25
Proportion of directors receiving remuneration	6.70%	0.1036	0.00%	54.55%
Proportion of female directors in all directors	19.05%	0.1511	0.00%	66.67%
Average age of directors	56.35	5.70	38.40	78.00
Number of board meetings	2.40	1.15	1	11
Proportion of government officials in all directors	2.55%	0.1066	0.00%	100.00%
Proportion of directors who have served as provincialand ministerial level leaders in all directors	7.59%	0.1671	0.00%	75.00%
Size of supervisory board	1.94	1.32	1	9
Proportion of female supervisors in all supervisors	30.89%	0.4039	0.00%	100%
Average age of supervisors	54.73	9.09	31.00	79.00
Type of non-profit foundations (private non-profitfoundations)	56.7%

Table 2 presents the factors associated with the total income of NPFs. After controlling for net assets, NPFs with more number of directors (B = 0.062, p < .01), fewer government officials among all directors (B = −0.008, p < .05), and larger size of supervisory board (B = 0.230, p < .01) performed better in terms of total income. Notably, in comparison with private fundraising NPFs, public ones performed better in terms of total income (B = 0.777, p < .01). In the sample of public fundraising NPFs, those having more paid (B = 0.035, p < .05) and younger directors (B = −0.066, p < .05), more directors who have served as provincial- and ministerial-level government officials (B = 0.021, p < .1), and owning a larger size of supervisory board (B = 0.313, p < .1) performed better in terms of total income. In the sample of private NPFs, the size of the board of directors (B = 0.756) positively affected the foundation’s total income (p < .05).

Table 2.

Factors Associated With Total Income in Non-Profit Foundations.

	All non-profit foundations (n = 203)			Public non-profit foundations (n = 88)			Private non-profit foundations (n = 115)
Variables	B	Beta	p-value(two-tailed)	B	Beta	p-value(two-tailed)	B	Beta	p-value(two-tailed)
Constant	18.413		.000	18.825		.000	18.423		.000
Size of the board of directors	0.082	.257	.000	0.054	.154	.141	0.093	.309	.002
Proportion of directors receiving remuneration	0.013	.070	.282	0.036	.210	.041	−0.009	−.050	.598
Proportion of female directors in all directors	−0.001	−.006	.927	0.013	.087	.383	−0.002	−.022	.831
Average age of directors	−0.069	−.246	.001	−0.070	−.263	.025	−0.062	−.214	.061
Number of board meetings	0.118	.073	.258	0.134	.054	.587	0.062	.049	.597
Proportion of government officials in all directors	−0.024	−.139	.063	−0.022	−.149	.197	−0.012	−.055	.635
Proportion of directors who have served as provincialand ministerial level leaders in all directors	0.023	.203	.009	0.035	.358	.003	−0.001	−.007	.950
Size of supervisory board	0.354	.249	.000	0.459	.284	.006	0.300	.242	.014
Proportion of female supervisors in all supervisors	0.000	−.009	.893	−0.002	−.051	.614	0.000	−.006	.948
Average age of supervisors	0.002	.008	.909	0.001	.004	.973	0.001	.003	0.977
Type of non-profit foundations (Referent is public non-profit foundations )	0.634	.169	.013
R-square	0.265			0.309			0.217
F-statistic	6.219			3.403			2.889
p-value	<.001			.001			.003

Note. Dependent variable: Ln_totalincome. B is unstandardized coefficient and Beta is standardized coefficient.

Table 3 presents the factors associated with donation income in NPFs. In the total sample of NPFs, the size of the board of directors (B = 0.061) and the size of the supervisory board (B = 0.371) were positively associated with donation income (all p < .05), whereas the proportion of government officials among all directors was negatively associated with donation income (B = −0.008, p < .01). Among public NPFs, the proportion of directors receiving remuneration (B = 0.035, p < .05), the proportion of directors who have served as provincial- and ministerial-level leaders among all directors (B = 0.021, p< .1), and the size of the supervisory board (B = 0.313, p < .1) affected the donation income positively, whereas the average age of directors had a negative effect (B = −0.066, p < .05). In the sample of private NPFs, the size of the board of directors (B = 0.756) positively affected donation income (p < .05).

Table 3.

Factors Associated With Total Donation Income in Non-Profit Foundations.

	All non-profit foundations (n = 203)			Public non-profit foundations (n = 88)			Private non-profit foundations (n = 115)
Variables	B	Beta	p-value(two-tailed)	B	Beta	p-value(two-tailed)	B	Beta	p-value(two-tailed)
Constant	17.986		.000	16.989		.000	19.594		.000
Size of the board of directors	0.061	.161	.040	0.012	.026	.823	0.079	.243	.018
Proportion of directors receiving remuneration	0.016	.078	.288	0.061	.272	.019	−0.034	−.172	.088
Proportion of female directors in all directors	0.002	.013	.860	0.022	.120	.282	−0.002	−.017	.874
Average age of directors	−0.061	−.182	.033	−0.057	−.162	.236	−0.074	−.235	.045
Number of board meetings	0.083	.044	.541	−0.039	−.012	.912	0.132	.098	.309
Proportion of government officials in all directors	−0.003	−.016	.853	0.009	.046	.725	−0.003	−.011	.932
Proportion of directors who have served as provincial and ministerial level leaders in all directors	0.003	.021	.811	0.008	.066	.610	0.003	.017	.895
Size of supervisory board	0.371	.215	.003	0.561	.270	.018	0.200	.142	.174
Proportion of female supervisors in all supervisors	0.000	.006	.940	−0.003	−.057	.621	−0.002	−.056	.601
Average age of supervisors	0.003	.012	.886	0.022	.079	.546	−0.006	−.029	0.787
Type of non-profit foundations (Referent is public non-profit foundations)	0.360	.082	.278
R-square	0.112			0.156			0.213
F-statistic	2.096			1.371			2.647
p-value	.023			.210			.007

Note. Dependent variable: Ln_totaldonationincome. B is unstandardized coefficient and Beta is standardized coefficient.

Table 4 shows the factors associated with investment income. In the private nonprofit sample, the proportion of female directors among all directors (B = 0.094, p< .1) and the size of supervisory board (B = 1.487, p< .1) were positively associated with investment income. The result of the public nonprofit sample indicates that the board composition was not associated with investment income in public fundraising NPFs.

Table 4.

Factors Associated With Total Investment Income in Non-Profit Foundations.

	All non-profit foundations (n = 203)			Public non-profit foundations (n = 88)			Private non-profit foundations (n = 115)
Variables	B	Beta	p-value(two-tailed)	B	Beta	p-value(two-tailed)	B	Beta	p-value(two-tailed)
Constant	18.281		.000	17.267		.000	19.636		.000
Size of the board of directors	0.093	.248	.016	0.103	.295	.131	0.104	.254	.043
Proportion of directors receiving remuneration	0.031	.143	.149	0.031	.176	.305	0.045	.160	.207
Proportion of female directors in all directors	0.008	.055	.556	−0.005	−.039	.814	0.015	.104	.429
Average age of directors	−0.032	−.092	.387	−0.007	−.027	.902	−0.072	−.150	.265
Number of board meetings	0.054	.029	.750	0.790	.206	.243	−0.052	−.032	.783
Proportion of government officials in all directors	−0.043	−.081	.390	0.022	.034	.837	−0.058	−.115	.352
Proportion of directors who have served as provincial and ministerial level leaders in all directors	0.018	.109	.258	0.015	.121	.453	0.033	.158	.224
Size of supervisory board	0.403	.219	.021	−0.137	−.079	.653	0.655	.346	.004
Proportion of female supervisors in all supervisors	−0.003	−.058	.530	0.005	.089	.587	−0.006	−.101	.402
Average age of supervisors	0.005	.017	.865	−0.025	−.108	.592	0.011	.036	.779
Type of non-profit foundations (Referent is public non-profit foundations)	−0.617	−.134	.181
R-square	0.146				.156		0.243
F-statistic	1.725				.684		2.054
p-value	.077				.733		.042

Note. Dependent variable: Ln_totalinvestmentincome. B is unstandardized coefficient and Beta is standardized coefficient.

Discussion

The findings verify the relationship between the size of the board of directors, the size of the supervisory board, the average age of the board of directors, the proportion of the board of directors who receive remuneration, the proportion of government officials, and directors who have served as provincial- and ministerial-level leaders in the board of directors and the performance of NPFs. The empirical results show the following.

Board Size Positively Affects Organizational Performance

The resource dependence theory advocates that external resources are the main driving force for the survival and development of organizations (Pfeffer & Salancik, 1978). Upon securing certain resources, assuring their preservation through strategies such as cooperation (Olson, 2000) or exchange, thereby amplifying the role of these resources. In this case, NPFs are willing to bring more board members, because they can bring more resources, with revenues being the most important. The theory also suggests that new board members will bring new resources to the organization (Olson, 2000).

Empirical conclusions in this field mostly confirm the relationship between the board size and financial performance of NPOs (L. L. Liu, 2015), which is consistent with the finding of this study. However, interpretations may vary due to the diverse definitions of financial performance that are used. In addition, total, donations, and investment incomes were selected as indicators of financial performance in most studies. Few studies have also argued that a large board size can lead to inefficient management due to increased costs related to internal organizational matters, such as communication, coordination, and decision making (De Andrés-Alonso et al., 2010; Marcuello, 1998). However, this is conditional and not necessarily be universally true. The cost of communication increases only with the full participation of the board members.

The Size of the Supervisory Board is Positively Associated With Total and Donation Incomes

Supervisory board exists within the organization and is independent of board of directors. In China, NPF supervisors shall inspect the financial and accounting information of the foundation in accordance with the procedures stipulated in the articles of association. They should also supervise the compliance of the board of directors with laws and articles of association. Supervisors have the right to attend meetings of the board of directors; raise inquiries and suggestions to the board of directors; and report the situation to the registration and management authority, business supervisory units, and tax and accounting authorities (Zhang & Li, 2013). The board of directors is the decision-making body, whereas the board of supervisors is the supervisory body, which oversees the board of directors and other functional departments. The members of the supervisory board shall be experts, scholars, and government officials employed by institutions. Supervision and restraint mechanism is an important part of internal governance, playing a key role in improving the credibility of organizations. In line with the agency theory, the relationship between the donor and the board conforms to the principal–agent relationship, carrying risks related to information asymmetry. Donors, especially small and medium-sized ones, often lack the motivation and ability to supervise the operation of foundations. At the same time, as the beneficiaries receive assistance at zero cost, they cannot intervene excessively with the foundation, making the principal–agent problem in the operation of the foundation more prominent and requiring fairer and more effective supervision (Zhang & Li, 2013). Some studies on China’s NPFs have shown that no significant correlation exists between the size of the board of supervisors and financial performance of NPOs (L. L. Liu, 2015; Zhang & Li, 2013). The dependence of supervisors and the absence of supervision function must be the probable reason. Thus, the board of supervisors does not directly influence financial performance. However, issues in the conduct and supervision of the board of supervisors can hinder its ability to fulfill its supervisory role effectively, leading to potential failures in achieving its intended purpose. One possible reason is that the sample data of this study are after the enactment of the Charity Law in 2016. This law regulates the behavior of the board of supervisors and promotes internal supervision. Moreover, foundations may have strengthened the construction of the board of supervisors to avoid the risk of breaking the law.

The Average Age of Directors is Negatively Correlated With the Total Income in Public NPFs and With the Donation Income in All NPFs

The result is basically consistent with the existing research (L. L. Liu, 2015; H. P. Liu et al., 2016). Under the special political and social relations in China, the high average age of council members is unfavorable to the fundraising of NPFs. The external management of foundations in China tends to have a pronounced government-led influence. Business authorities have a strong control over NPOs (L. L. Liu, 2015). Older directors and supervisors often lose their innovation and vitality when implementing internal supervision because of their deep relationships with the competent units. Among the three performance indicators selected in this study, the average age of directors shows a negative correlation with total and donation incomes in all NPFs, but not with investment incomes. Total income mainly includes donation incomes, government subsidies, and investment incomes. The latter two are not necessarily related to the age of the board of directors. They mainly depend on the relationship between the institution and the government, the internal governance ability of the institution, and the investment mode chosen. Older directors and supervisors often lose their innovation and vitality in internal governance.

Performing Better in Total Income Is More Likely in NPFs With Fewer Government Officials Among All Directors

Although this study mostly aligns with existing Chinese literature, some minor discrepancies were observed. L. L. Liu’s (2015) study showed that the proportion of civil servants on the board of directors does not significantly affect financial performance. However, having a higher proportion of provincial and ministerial officials positively correlates with financial performance. Zhang and Li (2013) found that leaders’ political contacts are not related to financial performance. This study considers that the proportion of provincial and ministerial officials is positively correlated with the total income. Such members of the board have political resources, special social capital, and network resources, and can better mobilize society and raise funds for organizations (L. L. Liu, 2015). This finding presents the characteristics described by the resource dependence theory, maintains a good relationship with external stakeholders, and can better access resources (Pfeffer & Salancik, 1978). The administrative dominance of China’s political and social relations is largely manifested in the dominance of personnel and resource allocation, and the dominance of personnel will affect the ability to obtain resources. Provincial and ministerial officials control government resources and even have great power to allocate resources in a certain field, which will naturally win more resources for their organizations to a large extent.

The empirical result also shows that the proportion of government officials on the board is negatively correlated with the total income, which cannot be well explained at present. From the perspective of resource dependence theory, this result may be somewhat confusing because the theory suggests that diversity within a board of directors can bring diverse resources to the organization, potentially affecting its strategic direction (Brown, 2005). In addition, having more directors with government official status can bring more resources to organizations, including revenues. One possible explanation is that the large proportion of civil servants on the board of directors will increase the political influence of decision making. Political intervention reduces the autonomy of foundations and thus total income.

The difference between public and private fundraising foundations lies mainly in the scope and method of collecting donations. Public fundraising is for the general public. The public tends to choose institutions with good internal governance and high credibility. Foundations with small average directors are more likely to be dynamic and innovative in internal governance. Moreover, internal governance will be more effective in those foundations with a larger size of board of supervisors. As for the influence of the proportion of provincial and ministerial officials on the total revenue of public foundations, institutions, as public NPFs, rely more on institutional and mobilizing donations. Conversely, the political resources of officials at or above the provincial and ministerial levels can help them win more public donations. Private fundraising foundations mainly rely on directional fundraising. Even if the proportion of public donations is extremely small, as long as it can successfully obtain high-quality qualitative donation resources, it will also have a highly objective total income. The size of the board of directors and the size of the board of supervisors significantly affect the total income of private fundraising foundations, given that the broad social resources of directors and supervisors will help foundations secure more targeted resources. Young directors accumulate less social resources, which may affect the influence of directional fundraising. The data also show that the size of the board of supervisors has an important influence on the total income of public and private foundations, which reflects that the board of supervisors plays an internal supervisory role and that the emphasis of Charity Law on supervision makes the supervisors of NPFs perform better functions.

In Public Fundraising NPFs, the Proportion of Directors Who Receive Remuneration Is Positively Correlated With Total and Donation Incomes, Whereas in Private Fundraising NPFs, They Show No Correlation

From the perspective of agency theory, the primary function of boards as monitoring the actions of “agents,” who are essentially the managers, to protect the interests of “principals,” the owners (Hillman & Dalziel, 2003). This result shows the performance differences brought by different agency behaviors. How does the difference occur? According to resource dependence theory, the behavior and effectiveness of dependence depend heavily on changes in the external environment (Daily & Dalton, 1993) and type of organizations (Daily et al., 2002). In China, the promulgation of the Charity Law has changed the external environment for NPFs to obtain resources, especially for private fundraising NPFs, as they will compete with public fundraising NPFs in the public market. In public and private fundraising NPFs, the connection between members and organizations is shown differently. In public fundraising NPFs, more emphasis is laid on rules, norms, and systems. Reasonable remuneration is the promise given by the system to directors. In the contractual relationship between directors and foundations, remuneration and the governing behavior of directors are equivalent exchanges. Remunerated directors are more likely to give full play to their governing functions, thereby increasing the donation income of institutions. In many ways, the Chinese government has more stringent management of public NPFs than private NPFs. The directors and members of private fundraising NPFs rely more on trust, responsibility, and belief rather than institutions. When compensation is used to affirm the value of a director’s work, it will weaken his sense of faith, thereby reducing resource liaison and donation income. At the same time, potential targeted donors may affect their evaluation of the organization and redistribute their donation resources because of the excessive proportion of paid directors.

Currently, a significant portion of NPFs operates their asset management through a charitable trust. NPFs hand over assets to the trust company for management and are only responsible for project operation. Such a situation exists more in private NPFs because legislation gives private NPFs more space to explore. Therefore, investment income is mainly related to the main body of investment management and the selected mode of investment, but not to the board of directors and the board of supervisors. However, if the board’s decision making is conducive to the selection of more effective investment methods, or the board can promote cooperation with the trust, then it will promote investment income. Therefore, in this respect, the board of directors and the board of supervisors of public NPFs in China have not made effective decisions on the choice of investors and investment methods.

Conclusion

Generally, this study draws valuable conclusions on the relationship between the board of directors and the organizational performance of NPFs. Empirical research has indicated a correlation between some characteristics of the board of directors and organizational performance. Board size is positively correlated with organizational performance. The size of the supervisory board is positively associated with total and donation incomes. The average age of directors is negatively correlated with total income in public NPFs and with the donation income in all NPFs. In foundations with fewer government officials among all directors, they perform better in terms of total income. In public fundraising NPFs, the proportion of directors who receive remuneration is positively correlated with the total and donation incomes, whereas in private fundraising NPFs, they show no correlation.

This study has significant implications for understanding the relationship between board composition and organizational performance among NPFs in China after the enaction of the Charity Law. Many aspects of the board characteristics of foundations are closely related to financial performance, such as the size of the board of directors, the size of the supervisory board, the average age of directors, and the proportion of directors who have served as provincial- and ministerial-level leaders among all directors. In pursuit of high financial performance, foundations should expand the size of the board of directors and the board of supervisors to the extent permitted by the law. They should adjust the age structure of the members of the board of directors and maintain the innovation and vitality of internal governance. For private fundraising NPFs, they should try their best to expand the size of their supervisory board. In addition, public foundations should standardize the salary system management. An innovation of this study is to consider the data of private NPFs, such that the data can be compared between public and private foundations. Empirical conclusions show differences between public and private foundations, which are interesting findings worthy of our discussion.

For future research on performance of NPFs in China, scholars need to pay special attention to the changes in China’s charitable legal environment, which is an important background in this study. Under the promulgation of the Charity Law, the regulatory environment, regulatory methods, and operational methods of NPFs have undergone changes. This study offers findings that differ from previous research and provides valuable insights to enhance the performance of NPFs, making it beneficial for managers and policy makers.

Limitations

This study has several limitations that should be noted. The measurements of board characteristics and effectiveness did not cover all elements of nonprofit board and organizational effectiveness mentioned in the literature due to data unavailability. Another limitation is that the cross-sectional data could not establish the causal relationship between governance structure and organizational performance. The authors should admit that there exists a limitation of selecting cross-sectional data from 2017 because the study was conducted in 2018. The authors could only obtain cross-sectional data from 2017 in 2018. Future works need to use panel data to examine the causal relationship. Despite the limitations of this study, the use of a national dataset increases the generalizability of the findings.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by National Social Science Fund of China (22BZZ031) and the Fundamental Research Funds for the Central Universities (23JNQMX06).

ORCID iDs

Zhou Yuanyuan

Lin Weny

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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Association Between Board and Organizational Performance Among Nonprofit Foundations in China

Abstract

Plain language summary

Keywords

Introduction

Literature Review

Core Elements of Organizational Performance

Financial Performance

NFP

Core Elements of Board and Its Relation With Organizational Performance

Board Size and Structure

Gender Diversity

Other Characteristics

Theoretical Background and Hypotheses

Theoretical Framework

Hypotheses

Methods

Data Source

Dependent Variables

Independent Variables

Data Analysis

Results

Discussion

Board Size Positively Affects Organizational Performance

The Size of the Supervisory Board is Positively Associated With Total and Donation Incomes

The Average Age of Directors is Negatively Correlated With the Total Income in Public NPFs and With the Donation Income in All NPFs

Performing Better in Total Income Is More Likely in NPFs With Fewer Government Officials Among All Directors

In Public Fundraising NPFs, the Proportion of Directors Who Receive Remuneration Is Positively Correlated With Total and Donation Incomes, Whereas in Private Fundraising NPFs, They Show No Correlation

Conclusion

Limitations

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iDs

Data Availability Statement

References