An Empirical Taxonomy of Hospital Governing Board Roles

Abstract

Objective. To develop a taxonomy of governing board roles in U.S. hospitals. Data Sources. 2005 AHA Hospital Governance Survey, 2004 AHA Annual Survey of Hospitals, and Area Resource File. Study Design. A governing board taxonomy was developed using cluster analysis. Results were validated and reviewed by industry experts. Differences in hospital and environmental characteristics across clusters were examined. Data Extraction Methods. One-thousand three-hundred thirty-four hospitals with complete information on the study variables were included in the analysis. Principal Findings. Five distinct clusters of hospital governing boards were identified. Statistical tests showed that the five clusters had high internal reliability and high internal validity. Statistically significant differences in hospital and environmental conditions were found among clusters. Conclusions. The developed taxonomy provides policy makers, health care executives, and researchers a useful way to describe and understand hospital governing board roles. The taxonomy may also facilitate valid and systematic assessment of governance performance. Further, the taxonomy could be used as a framework for governing boards themselves to identify areas for improvement and direction for change.Key Words. U.S. hospitals, governing boards, taxonomy Developments, such as Sarbanes-Oxley legislation, scrutiny by the Internal Revenue Service, concern for medical errors and patient safety, demand for performance by third-party payers, and competition from physician-owned health care facilities, have placed governing boards of hospitals in a more critical position responsible and accountable for hospital affairs (Orlikoff 2005). Observers and students of governance generally agree that effective governing boards are the sine qua non of effective hospitals and that governing boards need to assume a more active role in order to successfully guide their organizations through the turbulent waters of today's health care environment Prybil 2006 While it is recognized that governing boards all have a clear goal--to build and sustain an effective organization--what they actually do to accomplish that goal differs greatly. In part because of the flexibility afforded them by state laws of incorporation and relatively weak oversight, hospital governing boards have interpreted and discharged their roles with an unsettling degree of variation (Weil 2003;Orlikoff 2005). Some boards act mainly as policy makers, focusing on establishing mission and a strategic direction for the hospital; others assume the role of boundary spanners, focusing on building and maintaining relations with key external constituencies and fundraising; while still others devote much of their time and attention to overseeing the performance of the hospital and its management team (Widmer 1993). In the past, the variability with which hospital boards discharged their roles could be tolerated, given the common perception that governance contributed little value to the organization or the community (Star...

The impact of the board’s strategy-setting role on board-management relations and hospital performance

“…Similar studies concerning governing boards present comparable response rates of approximately 20% (Ford-Eickhoff et al, 2011;Lee et al, 2008). Our survey was conducted in three phases.…”

“…Lee, Alexander, and Wang (2008) have developed a taxonomy for hospital governing board roles by clustering governing boards with regard to their three main board roles (strategy-setting, performance evaluation and oversight, and external relations). Several studies have examined the impact of the governing board's strategy-setting role on financial performance in the hospital context.…”

Effective board governance of safe care: a (theoretically underpinned) cross-sectioned examination of the breadth and depth of relationships through national quantitative surveys and in-depth qualitative case studies

“…19,27 For example, the 65-item Board Self-Assessment Questionnaire (BSAQ) has recently been used in studies of hospital boards in the USA 28 and a small-scale study of FTs in England. 29 The benefit of theoretically informed instruments such as the BSAQ is that they have predictive power and can be used to assess the implications of adopting different board strategies (rather than merely taxonomic uses).…”

Defining the Functions of Public Health Governance

“…We independently reviewed the materials and developed a list of themes, and then discussed the findings to further refine the thematic categories and identify key elements to include in the definitions. We identified 6 strong themes that concerned the roles and responsibilities of governing boards: policy development (addressed in 86% of articles reviewed, or n = 38) 18,24–26,30–63 ; resource stewardship (50%, or n = 22)18,24,26,30–32,37,38,40,41,44,45,47,48,50,54,56,57,59,60,63,64; partner engagement (50%, or n = 22)18,24–26,30–34,37,38,40,44,45,48,49,53,55,59,60,62,65; continuous improvement (73%, or n = 32)18,24–26,30–33,35,36,38,40–43,45,46,48,49,51,54–61,63,66–68; legal authority (25%, or n = 11) 18,24,26,38,39,41,52,57,60,61,67 ; and oversight (57%, or n = 25) 18,24,26,31,32,34,38,39,41,43–45,50,52,…”