What Does Governance Look Like in the Country's Largest Health Systems? 8 Major Findings

The Commonwealth Center for Governance Studies has released its report, "Governance in Large Non-Profit Health Systems," which analyzes governance and leadership trends in 14 of the country's most sizable hospital organizations.

Surveyed systems include Adventist Helath System (Altamonte Springs, Fla.); Ascension Health (St. Louis); Banner Health (Phoenix); Carolinas HealthCare System (Charlotte, N.C.); Catholic Health East (Newton Square, Pa.); Catholic Health Initiatives (Englewood, Colo.); Catholic Health Partners (Cincinnati); Christus Health (Irving, Texas); Kaiser Foundation Hospitals and Health Plan (Oakland, Calif.); Mayo Clinic (Rochester, Minn.); Mercy (Chesterfield, Mo.); Providence Health & Services (Renton, Wash.); Sutter Health (Sacramento); and Trinity Health (Novi, Mich.).

Senior trustees and CEOs were surveyed in site visits conducted in the latter part of 2010 and 2011. Independent interviews were conducted with all 14 CEOs and a total of 57 board members.

1. Size of system boards
• Fewer than nine voting members: 0
• Nine to 17 voting members: 10
• 18 to 28 voting members: 3
• More than 28 voting members: 1

2. Board members' and CEO's views about the size of their boards
• It's somewhat too large to be efficient: 24 percent
• The present size is just about right: 65 percent
• We should expand its size to provide broader input: 4 percent
• Other: 7 percent

3. Independent vs. non-independent board members
• Independent: 60 percent of board members
• Non-independent: 40 percent of board members
*Independent board members are defined as persons who are not a member of a sponsoring body, such as a congregation, not a full- or part-time employee and not directly affiliated with the system in any other way than serving as a board member.

4. Racial composition of large system boards
• Non-Caucasian members: 17 percent of board members
• Caucasian members: 83 percent of board members

5. Gender composition of large system boards
• Women: 33 percent of board members
• Men: 67 percent of board members

6. Clinician composition of large system boards
• Nurses: 6 percent of board members
• Physicians: 14 percent of board members
• Other: 80 percent of board members

7. "What's your overall opinion about the current composition of your board?"
• Board deliberations would benefit from additional expertise: 59 percent
• Board deliberations would benefit from greater diversity in perspectives: 21 percent
• Board deliberations would benefit from having more independent directors: 7 percent
• The present composition is just about right: 13 percent

8. "Has your board adopted formal succession plans for board and senior management positions?"
• Yes, for the board chair, board committee chairs, CEO and other senior management positions: 43 percent
• For the CEO and other senior management positions but not for board positions: 29 percent  
• For board leadership positions but not for senior management: 7 percent
• We have no yet adopted any formal succession plans: 21 percent

More Articles on Hospital Governance:

7 Tips for Physician Representation in Hospital Governance
Study Reveals Shortfalls in Hospital Boards' Involvement in Quality Efforts
10 Ways Leaders Can Sink a Health System

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