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Hospital Governing Boards and Performance


It is important for a hospital to run effectively, afford quality care, and sustain a high-quality status in the community it serves. The performance of hospitals is of great concern to societies in their quest for improving health; hence, the correlation of board performance to hospital’s performance is a subject of concern. Healthcare boards are held responsible for the general performance of the institutes they serve, and are accountable to the relevant communities as far as access to high quality care and public wellbeing is concerned. Governing boards and managerial heads deal with a number of issues that incorporate board’s efficacy, and organizational performance. In the healthcare field, governing boards are getting increasing public attention due to their failures in limiting bankruptcies, dissolutions and losses.

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Unluckily, several boards are uncertain about their positions in spear heading organizations towards success. The challenges have accordingly led to corporate turnarounds, insolvency, unsuccessful mergers and acquisitions, shutting down and complexity in employing healthcare recruits (Orlikoff & Totten, 2003). It is hence vital to comprehend the dynamics that contribute to governing boards’ performances on top of the associations among the governing board performances and general hospital performances. This article is about investigating the aspects that establishes the performance of hospital governing boards and the linkage of governing board performances to organizational performance in hospitals.

Review of Literature

The objective of this literature review is a 2-fold. It is significant to discover the aspects that contribute to proficiency of governing boards and to comprehend how to advance performance levels in hospitals (Kovner, 1990). Primarily, it aspires to assess the association between the board efficiency and hospital performance. The second objective is to inspect the technique by which governing boards manipulate performance. This literature review deals with matters connected to governing boards and organizational performance in the commerce and healthcare divisions. It evaluates the present study that empirically relates board performance to organizational results and recognizes the gaps in the information. This research presents helpful information about governing board performances and assists to verify the correlation between governing boards and hospital performance. The examination is prepared into two sections, features of effectual boards, and the affiliation of governing board performance and hospital performance.

Organizational Performance

This research focuses on a number of abstract viewpoints, which assists in giving details of how and why boards might influence managerial performance. Organizational performance is perhaps the most widely employed dependent variable in organizational study today yet at the same time it remains one of the most blurred and slackly distinct notions. The struggle to set up a meaning of performance has been continuing for many years, and it is not restricted to the field of organizational management (Brown, 2005). Performance prospects are established through many ways, including precedent performances and benchmarking with other facilities using national measures of results. Hospital managerial performance can be assessed by evaluating how hospitals rank in the Joint Commission Accreditation Healthcare Organization.

The Joint Commission, which began in 1987, assesses and accredits healthcare organizations to continue enhancing wellbeing as well as value of care provided to the public through provisions of healthcare support and hospital performance improvement. The Joint Commission grades hospitals in order based on the achievement of the seven performance indicators. These indicators are (1) risk adjusted death rates, (2) risk adjusted complication rates, (3) severity-adjusted average length of stay, (4) expenditure per adjusted discharge, (5) profitability, (6) cash flow debt to ratio, tangle assets per adjusted discharge (7) increase in percentage of population cared for. To measure the primary reliant variable correlated to hospital performance, a questionnaire will be sent to CEO’s of all acute care community hospitals in Illinois. The feedback form will be based on the device given out by the Joint Commission Accreditation of Healthcare Organizations that can judge hospital performance in superiority of care and medical outcomes. A researcher will administer the questionnaire without employing a researcher assistant. Questions asked will not be loaded in any way; instead, they will be simple and easy to understand. A questionnaire is a standardized data collection tool that guarantees fairness and generates consistent results. Every head of a health care will be requested to give his/her views in form an answer. The questions will be prepared in ways that do not touch on the respondent’s prestige and self-esteem. In places that are not accessible, such as in deep rural areas or in places that the sampled population is scattered, the researcher might not be able to visit each interviewee. In such places, questionnaires are mailed or posted then the healthcare heads are urged to fill them. At some stage in the research exercise, the respondents will be supervised by calling them to inquire about how they are progressing in answering the questions. Follow up in scientific research is very important because it facilitates efficiency in the whole process.

The type of research design to be undertaken will take a form of a survey. This involves a process whereby a small population is chosen to represent the whole population. Surveying research is a less time consuming activity and again it is cheap to conduct. All healthcare officials cannot be sampled because the process could be time consuming and expensive. Any research should be economical, meaning that resources should be utilized efficiently in any investigative study. The researcher will therefore make a decision in advance pertaining to the population to be sampled. Sampling consequently is an important element in any this study. The research establishes how many healthcare heads should be examined as well as which specific questions should be asked. When selecting the healthcare officials to be sampled, the investigator will use random sampling method. This is the only way the sampling bias can be avoided. Sampling bias arises when the researcher favors some individuals in selection. For this reason, the researcher in this study will come up with a certain criteria of sampling that ensures every group is represented in the study.

Brown (2005) elucidated that fiscal performance indicators present feasible data in fundraising efficacy and communal backing and monetary performance. The data obtained can gauge organizational performance. According to the Agency for Healthcare Research and Quality (2007), organizational performance was assessed by having a board of quality committee, launching premeditated target for quality improvement. Other qualities that are found to be augmenting organizational performance include being engaged in setting the quality schedule for the hospital, covering a specific item concerning quality in board meetings, using national standard that includes indicators for clinical quality, patient wellbeing, and patient fulfillment and associating senior executives’ performance assessment to quality and patient safety indicators. An investigation showing the connection between hospital board performances and an organization is of assistance to the healthcare sector.

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Board Performance

In this research, board performance is evaluated by the scores of six elements of board competencies acknowledged in the Board Self Assessment Questionnaire (BSAQ). The BSAQ is a device used in study in nonprofit organizations. The six aspects of board proficiencies are:

  1. Contextual,
  2. Educational,
  3. Interpersonal,
  4. Investigative,
  5. Political,
  6. Strategic.

These magnitudes are to be defined in the subsequent section in fine points and employed as the independent variables for this study. BSAQ give out scores for individual panel members and the individual panel member scores are averaged to attain a hospital-specific performance for each of the six board competencies.

Chait, Holland and Taylor (1993) carried out a research on nonprofit governing boards and their success. The examination involved six behavioral factors that include contextual, Educational, Interpersonal, Analytical, Political, and Strategic.

  1. The Contextual dimension means that the board is aware and takes into account the customs, morals, and norm of the organization it presides over. Any decision made by the governing body should be in line with the organizational goals and or objectives.
  2. Educational aptitude means the board takes crucial steps to guarantee that members are knowledgeable about the organization and its workforce over and above the board’s own roles, responsibilities and performance. For this to happen therefore, the board establishes various training programs including both on job training and on external training.
  3. Interpersonal stance is about management relationships; a well –performing board fosters the development of its members as a group, focus on the board’s interests, and works consistently with its members. An organization should empower its employees by offering incentives such as salary increment, training opportunities and coming up with policies that would guarantee solidarity among them.
  4. The effectual board has Analytical competency to be familiar with complex issues and is in a position to act in response appropriately. The board therefore should identify the capability of each employee.
  5. Political expertise means the board admits the need to build up and uphold healthy affiliation among all key components as a prime responsibility. The board ought to offer quality healthcare by availing all necessary equipments. Decision-making in an organization on the other hand should be free fair. Employees need to be involved in decision-making.
  6. Strategic proficiency means the board foresees and nature institutional course and assists to ensure a strategic approach to the organization’s expectations.

Board members are chosen by criterion that points out the board’s projected roles and reflect the endeavor to intensify specific board exclusivity. Bader (2001) illustrates eight doctrines of effective governance:

  • answerability as a board,
  • responsibility to govern but not manage,
  • commendable conduct,
  • mission motivated, meaning taking up responsibility where possible,
  • rationalized structures, implying that the board should always be scientific in decision-making
  • the managing board is supposed to have enough competency.

The investigator continues to argue that the board should engage itself in value-added work as well as to soldier on with self-replenishment. Payne et al. (2009) affirmed that the key obligation of governing boards of nonprofit healthcare institutes take into consideration five basics:

  • setting the course,
  • giving surety of valuable management,
  • improving the assets,
  • accomplishing quality objectives
  • standing-in as stakeholder on behalf of the public it serves.

Hospital governing boards bear decisive control, duty, and responsibility for an organization’s performance.

To sum up, the intention of this study is to scrutinize the factors that determine the performance of hospital governing boards and the connection between governing board performance and organizational performance in hospitals. There is a need of more research that evaluates board performance within a set of behavioral criteria, such as the six aspects of effective boards, and then weighs the data against the organization’s performance. Facts show that quantifying relative hospital performance using appraisal tools can improve organizational performance (Griffith, Alexander & Warden, 2002). By means of these system tools, the financial and organizational competence should be prioritized and give managers and executives a more ‘unbiased’ outlook of organizational performance. For that reason, undertaking research that contrasts performance of hospitals with self-assessed evaluations performance is significant and influential information for board expansion. The reviewed literature in this essay is critical in understanding the role of the top executive in managing the healthcares. It should also be understood that not all reviewed data is substantial for this study (McDonagh, 2006). Only a few literatures will be employed in writing up the conclusion of the study. Without reviewing literature, the study might end up generating many useless data. Literature review also keeps the researcher away from duplicating data that is the researcher produces something different.

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Brown, W. (2005). Exploring the association between boards and organizational performance in nonprofit organizations. Nonprofit Management & Leadership, 15, 317-339.

Chait, R., Holland, T.P. & Taylor, B. (1991). The effective board of trustees. Phoenix, AZ: Oryx Press.

Griffith, J. et al. (2002). Measuring comparative hospital performance. Journal of Healthcare Management, 47 (1), 41-47.

Kovner, A.R. (1990). Improving hospital board effectiveness: An update. Frontier of Health Services Management, 63(3), 3-27.

McDonagh, J.K. (2006). Hospital governing boards: A study of their effectiveness in relation to organizational performance. Journal of Healthcare Management, 51(6)

Orlikoff, J.E. & Totten, M.K. (2003). What board should know about turnarounds? Trustee, 56 (10).

Payne, G.T., Benson G.S., & Finegold, D.L. (2009). Corporate board attributes, tea effectiveness and financial performance. Journal of Management Studies, 46, (4)707731.

Pointer, D.D. & Orlikoff, J.E. (1999). Board work: Governing healthcare organizations. San Francisco: Jossey-Bass Publishers.

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Poister, T.H. & Streib, G. (2005). Elements of strategic planning and management in municipal government: Status after two decades. Public Administration Review, 65 (1) 45-56.

Totten, M.K. & Orlikoff, P.O. (2006). Governance at the crossroads. Healthcare Executive, 21, 38-41.

Taylor, B., Chait, R. & Holland, T.P. (1996). The new work of the nonprofit board. Harvard Business Review , 74 (5) 36-46.

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