Governance in Large Nonprofit Health Systems: Current Profile and Emerging Patterns

Original content published in the January 2012 issue of Trustee magazine, Vol. 65, No. 1. © 2012 by Health Forum Inc. All rights reserved. Permission granted for digital use only.

By Mary K. Totten and Lawrence Prybil

Much has been written about our nation’s health care organizations’ grappling with forces that demand new delivery and payment models focused on more accountable, value-driven care.That’s the big picture. But what does the perspective look like on the ground? How are health care organizations reacting and adapting?

New research on board structures, practices and culture in large nonprofit systems provides insight into how boards and CEOs are addressing the challenges of change — and changing the way they govern in the process. is workbook explores several themes emerging from review of system documents and 71 on-site interviews with CEOs and senior board leaders in 14 of the country’s 15 largest nonprofit health care organizations. In cooperation with the American Hospital Association, the study team in fiscal 2010 selected participating systems using a blend of three measures of size: annual systemwide operating expenses, number of facilities in the system and number of counties in which those facilities are located. Participating systems are listed on page 17.

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