Improving hospital board effectiveness: an update.

This article defines governance as the making or not making of important decisions and the related distribution of legitimate power and authority to make them. A distinction is drawn between what governing boards do that is not restricted to governance, and governance that is not the exclusive function of governing boards. This article focuses on governing boards. Recommendations are made for improving the effectiveness of hospital governing boards. Discussed in detail are integrating clinician and administrative governance; supporting management in managing change; focusing and energizing the board on policymaking; and, specifying and evaluating the hospital's contribution to the health of a defined population at reasonable cost. The author surveys the current hospital environment and reconsiders and updates his 1985 recommendations on improving governance. Board effectiveness is reconceptualized, and those recommendations that have been made to improve board structure and function are reviewed. Governing boards are shown to work differently in multihospital systems, hospital alliances, and under restructuring. A research agenda to improve hospital board effectiveness is proposed.