Governance Research

Governance in High-Performing Health Systems: A Report on Trustee and CEO Views

Led by Lawrence D. Prybil, M.A., Ph.D., a professor of health management and senior advisor to the dean of the University of Iowa College of Public Health, and a member of the Center’s National Board of Advisors, this research report examines the structures, practices, and cultures of community health system boards and compares them to several benchmarks of good governance.

This research report examines the structures, practices, and cultures of community health system boards and compares them to several benchmarks of good governance. Its conclusions and recommendations get down to straightforward practical measures that a hospital or health system board can implement. Among others, they include blueprints for evaluation of the board’s strategic and bread-and-butter performance, plus review of membership composition. Well-noted are recommendations for essential board development and attention to community benefits. These and other areas provide a roadmap for needed change in our boards plus the rationale for why this makes sense.

This study was not designed to analyze the statistical relationships between benchmarks of good governance and system operating performance. However, it’s clear there is substantial variation in the extent to which current board structures, practices, and cultures meet these benchmarks. There are major gaps, and they are more evident in low-performing and mid-range performing systems. On-site interviews with board leaders and CEOs in ten high-performing systems documented their views on the key factors that have contributed to their systems’ success — success that, in several instances, required a major turnaround. Whether these are simply coinciding factors or cause-and-effect, there is a very compelling argument for community health system boards to adopt the well-established principles for improvement that are presented here.

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