Trustee workbook 2. The challenges of system governance.
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Biomedical subjects
Publications and source records attributed to James E Orlikoff.
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Healthcare boards are entering a new era of heightened accountability, scrutiny, and reform. Sarbanes-Oxley legislation, Internal Revenue Service scrutiny, pressure from creditors and bond insurers, activist state attorneys general, media attention, and other forces have sharply increased awareness of the importance of governance and have also raised the bar on what is required of boards and what is considered best-practice governance performance. Yet good governance cannot be legislated. The structure, composition, and specific required functions of boards can be legislated or mandated, but the effective function of boards cannot. At the same time that governance faces this new era of accountability, it is also being bombarded with the legions of monumental challenges in the tumultuous healthcare field. Chief executive officers and their boards must be willing to recognize the challenges and risks to the field of governance in general and to their boards in particular. Furthermore, they must be willing to implement new strategies and approaches for successful governance, including becoming compliant with Sarbanes-Oxley requirements; conducting a comprehensive audit of the structure, function, composition, and culture of the board; and seeking board members from outside the community, among many others.
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Leading-edge health care boards are preparing for a new era of governance accountability by making sure they are meeting both established and emerging standards for good governance. Yet, "meeting the standards" is not the same as adopting best practices and striving for continuous governance improvement. Good, effective governance is not the same as great governance.
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High profile business failures such as Enron and AHERF have raised the public's consciousness about the governing board's crucial role in ensuring sound, ethical business practices. AHERF (the Allegheny Health, Education, and Research Foundation in Philadelphia) was the largest not-for-profit health care bankruptcy in history and has generated many lawsuits against the AHERF boards and individual trustees. The Enron bankruptcy will certainly result in lawsuits against its board and directors and has embarrassed board members profoundly.
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