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


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

With governance of all types of organizations being increasingly called into question, not-for-profit healthcare organizations are being scrutinized more closely than ever before. Further accenting that trend, reform of our entire healthcare system is likely to be hard upon us. Community health systems will need to deal with major organizational change, and their boards must be capable of understanding it, adapting to it, and monitoring its impact. To do so, chairs and CEOs will be responsible for their boards having the necessary structures, processes, and culture in place.

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. Having spent much of our professional careers in healthcare, as CEO and Trustee, we applaud the work of this dedicated team of researchers and urge careful reading of this report by all who are interested in governance, and in particular healthcare governance.

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