The ongoing realignment of the health care field has resulted in many community hospitals now being part of larger health care systems. These systems range from national organizations with hundreds of care delivery entities and other not-for-profit and for-profit subsidiaries to small, local, single-hospital systems that may also include ambulatory care facilities and other organizations focused on delivering services to populations of patients across the care continuum. Regardless of their size and scope, all systems are evolving in response to the increasing complexity arising from a field in transformation; and often their structure, function and governance reflect this complexity as well.
The good news is that, because systems have been forming for more than 20 years, some general observations can be made both about how they are developing and how they are being governed (Great Boards, Summer 2014). More than two decades of system development also has yielded practical experience about essential governance practices and stumbling blocks to avoid in creating an effective web of governance among multi-organizational systems with many, layered boards. This experience also has produced approaches and tools systems can use to further improve their governance.
This publication discusses observations and trends about system development and identifies models of governance that are emerging as new organizations form and determine what it really means to become a system. It also reviews issues and obstacles that can arise as models of governance change and suggests steps boards can take to address them on the path toward more effective system governance.