AHA 2022 National Health Care Governance Survey Report

Periodically since 2005, the American Hospital Association (AHA) has surveyed the nation’s hospitals and health systems to develop a comprehensive picture of the state of health care governance structures and practices in the United States. Consistent with trends in a health care field that continues to undergo substantial transformation, the AHA’s 2022 National Health Care Governance Survey report describes board structures, practices and focus areas that are continuing to evolve in the changing environment.

AHA collected survey data from 933 hospital and health system CEOs between November 2021 and March 2022. To provide a deeper longitudinal view, the survey gathered data on a variety of questions about board membership, structure and practices. Similar to the AHA’s 2018 and 2014 surveys, the 2022 survey also examined findings across all respondents and by system, system subsidiary hospital and freestanding hospital boards.

New questions in the 2022 report delved into aspects of diversity, equity and inclusion as well as board practices during the COVID-19 pandemic.

To help boards and executives put the results into perspective, the 2022 report provides commentary on survey findings from an array of governance experts as well as sets of discussion questions to help boards reflect on survey findings in the context of their own structure and practices.

To help readers better understand the survey results and their implications for board work, this report is divided into nine sections:

• Survey Methodology, which describes survey design and process.
• Board Composition, which addresses board size, member voting status, emeritus board members and outside board members.
• Board Diversity, which describes the make-up of boards across the dimensions of diversity including race/ethnicity, gender, age, among others.
• Board Structure, including term limits and term length, board compensation, board committees, and board restructuring and support.
• Board Selection, which describes board member competencies, board member replacement and effort required to recruit board members.
• Board Orientation and Education, which addresses position descriptions, orientation and education practices.
• Board Evaluation, including assessment types and focus, use of assessment results and board member evaluation criteria.
• Performance Oversight, which focuses on executive oversight, accountability and organizational performance.
• Board Culture, which addresses board meetings, executive sessions and time commitment for board work.

Health care is undergoing substantial transformation and board governance is also transforming to embrace that reality. The AHA’s 2022 National Health Care Governance Survey report, which is complimentary to members, describes board structures, composition, culture, diversity and other practices that are transitioning in today’s changing environment. The report highlights positive governance trends, identifies opportunities for improvement and includes insightful commentary from national governance experts.