Challenges of System Governance


Today, slightly more than 50 percent of the nation’s hospitals identify themselves as being part of a health care system. Systems come in all shapes and sizes. Some are large and comprise many hospitals across a wide region, including, among others, nursing homes, physician groups and insurance companies.

Others comprise several hospitals, as well as other entities, in close geographic proximity. And still others consist of a single hospital paired with only one other type of health care organization. Whatever their size and scope, governing a system is different from governing a freestanding hospital because systems must often accomplish several different purposes through several different organizations, all operating within the context of a rapidly changing health care and regulatory environment.

In the 1990s, when system formation and integration were on the rise, those studying these emerging organizations defined and characterized systems in ways that provide insight into the issues and challenges of managing and governing them. Stephen Shortell, Robin Gillies and others formally defined an organized delivery system as a network of organizations that provides, or arranges to provide, a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and the health status of the population served. The article, “Creating Organized Delivery Systems: The Barriers and Facilitators,” appeared in 1993 in Hospitals & Health Services Administration.

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