The ‘Quagmire’ of Hospital Governance in the USA

An interesting, and freely downloadable paper published this month in the Journal of Legal Medicine sets out the ‘legal quagmire’ of hospital governance in the US. The paper should appeal to ‘scholars’ of healthcare governance.

The paper concludes that “It is hard to deny that an effective board can have a beneficial impact on hospital operations, but it is difficult to appreciate the parameters of its role and even harder to identify the core mission of governance. The law in this area is deep and convoluted, drawing together threads of charitable trust and corporate doctrine in common-law and statutory contexts across the span of many years. Starting from a position of relative inattention, hospital boards have moved into a sea of directives, driven by growing numbers of public and private regulators and policy groups, and sparked recently by issues of asset allocation, community benefit, and quality.”

The article further states that “There is no paucity of ideas and suggestions related to hospital board operations, but a notable lack of foundational purpose characterizes this area.”

It is interesting that the ‘purpose’ of hospital governance should be the subject of confusion. John Carver, the World’s most published author on nonprofit board governance is clear that governance (i.e ‘the board’) exists to translate owners’ wishes into organisational performance. In a hospital context this usually translates into people presenting to the hospital achieving the best possible health outcomes cost-effectively.

Download The Quagmire of Hospital Governance – Finding Mission in a Revised Licensure Model here.

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