A perspective on local-level governance in multiunit systems.

The traditional functions of the hospital board are affected significantly when the institution is part of a multiunit system. The local board in multiunit systems often does not have the unrestricted ability to define its mission and goals and typically does not have total responsibility and authority for selecting, appointing, and evaluating the performance of the hospital's CEO. Some type of system-level involvement in shaping and/or approving the local institution's strategic plan and budget is common. Local boards generally have retained the principal role in the appointment and credentialing of medical staff members. In general, the continuing growth of multiunit systems has profound implications for the present and future role of local-level governance, but that role continues to have great importance and must be defined carefully.