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PubMed1989

Governing boards and profound organizational change in hospitals.

Over the past decade the importance of governing boards as policy-making setting and oversight units within organizations has increased dramatically. Although this is true for both corporate- and private-sector organizations (Bacon and Brown 1977; Gelman 1988), it is particularly relevant to the health sector. Hospital governing boards, long considered inconsequential in hospital management, have recently become subject to closer scrutiny. The role of governing boards in decisions affecting hospital strategy and hospital performance is once again a topic of some interest in boardrooms and hospital trade journals. Impressive evidence of the renewed interest in governance is provided by the funding of an instructional consortium by the S.K. Kellogg Foundation to help strengthen trusteeship and governing board decision making, and to improve education for health services managers in the area of governance. Members of the consortium include the Hospital Research and Educational Trust, the American Hospital Association, the American College of Healthcare Executives, and the Association for University Programs in Health Administration. Among the activities being undertaken by this consortium is the development of a self-assessment tool/methodology for boards, a bibliography and reference guide on effective governance for practicing trustees, research workshops for faculty in health administration programs, and a teaching guide on governance and trustee leadership. Despite this interest, the question with which we began this article persists. Do governing boards make a difference? In the course of our review of previous work on governance we found that, more often than not, that question has been transformed into: how do boards influence hospital performance? And very often that question has been further narrowed into: which board structure leads to better hospital performance? We have argued for a respecification of the initial question. Rather than pursuing a definition of the maximally performing governing board, we should perhaps shift our focus back to a fuller understanding of board structure and function, and its influence on hospital change. The model developed here combines four essential, and very basic, questions: 1. What are the basic dimensions that underlie structural variation in different types of governing boards? 2. How do these board types influence structural change in hospitals? 3. How is the effect of board influence on change itself likely to change over time as a function of the hospital's general pattern of growth, decline, stability, or instability?(ABSTRACT TRUNCATED AT 400 WORDS)

Decision Making, Organizational↗
PubMed1985

Multi-institutional arrangements: relationships between governing boards and hospital chief executive officers.

This investigation focuses on the impact of multi-institutional arrangements on the role of governing boards in limiting or enhancing the managerial autonomy of individual hospitals. Data from a 1979 Special Survey by the American Hospital Association (N = 4213) are used to examine governing board-administrator relationships as a function of the degree of autonomy and scope of responsibility of the hospital governing board. It is hypothesized that governing boards responsible for multiple hospitals or for multiple nonhospital organizations and those boards accountable to a higher organizational authority will exercise more formal control over hospital chief executive officers (CEOs) than will boards of single or autonomous hospitals. The analysis assumes that formal control by the governing board over the management function of the individual hospital is exercised partly through soliciting or limiting participation by hospital administrators in key policy decisions and through the evaluation of administrative performance. Therefore, it is anticipated that hospitals governed by boards with multiple responsibilities as well as hospitals governed by boards accountable to a higher authority will be (1) less likely to have CEOs who are members of the governing board executive committee, (2) more likely to have annual performance reviews of the CEO by the governing board, and (3) more likely to have such reviews conducted according to preestablished criteria. Study results provide general support for the hypotheses with respect to hospital boards with multiple responsibilities: the data suggest that such boards do exercise greater control over hospital administrators and these effects do appear to be stronger for hospitals in the private sector. Hospitals governed by boards accountable to a higher authority, however, are more likely to have CEOs who are members of the governing board executive committee--a pattern in direct opposition to that hypothesized. Furthermore, these boards are no more likely to conduct annual CEO performance reviews than are boards with more autonomy. Boards accountable to higher authorities are more likely, however, to use preestablished criteria when such reviews are conducted. This general pattern is similar whether hospital boards are accountable to religious authorities, to investor-owned corporate boards, or to the boards of not-for-profit multi-institutional systems. A different pattern emerges, however, for boards accountable to a state, county, or local government authority.(ABSTRACT TRUNCATED AT 400 WORDS)

Employee Performance Appraisal↗
PubMed1993

Corporate and philanthropic models of hospital governance: a taxonomic evaluation.

OBJECTIVE: We assess the theoretical integrity and practical utility of the corporate-philanthropic governance typology frequently invoked in debates about the appropriate form of governance for nonprofit hospitals operating in increasingly competitive health care environments. DATA SOURCES: Data were obtained from a 1985 national mailed survey of nonprofit hospitals conducted by the American Hospital Association (AHA) and the Hospital Research and Educational Trust (HRET). STUDY DESIGN: A sample 1,577 nonprofit community hospitals were selected for study. Representativeness was assessed by comparing the sample with the population of non-profit community hospitals on the dimensions of bed size, ownership type, urban-rural location, multihospital system membership, and census region. DATA COLLECTION: Measurement of governance types was based on hospital governance attributes conforming to those cited in the literature as distinguishing corporate from philanthropic models and classified into six central dimensions of governance: (1) size, (2) committee structure and activity, (3) board member selection, (4) board composition, (5) CEO power and influence, and (6) bylaws and activities. PRINCIPAL FINDINGS: Cluster analysis and ANCOVA indicated that hospital board forms adhered only partially to corporate and philanthropic governance models. Further, board forms varied systematically by specific organizational and environmental conditions. Boards exhibiting more corporate governance forms were more likely to be large, privately owned, urban, and operating in competitive markets than were hospitals showing more philanthropic governance forms. CONCLUSIONS: Findings suggest that the corporate-philanthropic governance distinction must be seen as an ideal rather than an actual depiction of hospital governance forms. Implications for health care governance are discussed.

Analysis of Variance↗
PubMedDate not supplied

Perceptions, knowledge, and commitment of clinical staff to shared governance.

The perceptions, knowledge, and commitment of clinical staff to shared governance were explored in a nonexperimental, survey research design, wherein preimplementation responses were compared to postimplementation responses. Using a nonprobability sampling method, all clinical staff members had the opportunity to respond to the Shared Governance Survey at the preimplementation and the 1-year postimplementation period. Thirty-eight clinical areas, including inpatient and outpatient areas, were included in the study. Both surveys contained a short demographic section and the Shared Governance Survey adapted from Minors et al. Results showed a decrease in perception and knowledge of shared governance between the 2 survey periods. This pattern was attributed to the idealism of shared governance in the preimplementation period compared to the reality of implementing shared governance. Interestingly, commitment to shared governance increased during this same time. When the sample was divided into groups, participants in shared governance had significantly higher scores on perception and knowledge of shared governance than did nonparticipants. Overall, participants and nonparticipants were committed to shared governance. The results of the survey indicated that clinical staff members recognized shared governance as a process, not a project, and that it takes time to share responsibility, accountability, and authority for nursing practice.

Attitude of Health Personnel↗
PubMed2005

[Study on insufficiency of government investment to the centers of disease prevention and control].

OBJECTIVE: To make clear the superaddition of government investment to the centers of disease prevention and control (CDC) which will ensure fulfillment of public functions of the center of disease prevention and control. Methods Centers of disease prevention and control had been sampled by two-stage stratified sampling method to investigate the status of government investment to the centers of disease prevention and control, which would be compared with the expected government investment to fulfill the public functions of CDC. RESULTS: According to the cost of manpower and the price in 2003, the government should give another 304.9% investment than current government investment (3.88 billions). For CDC of county level, the superaddition rate even reached 416.1%. The percentage of manpower expense would be 32.2% and the percentage of routine expense would be 67.8% of the superaddtion of government investment. The percentage of routine expense even reached 70.7% of the superaddtion of government investment. CONCLUSION: There was a big gap between the current government investment to CDC and the expected government investment to CDC. To fulfill the public function of CDC, the current government investment to CDC should increase by 3-4 times. The superaddition of government investment to CDC should be allocated more to the routine expense.

China↗
PubMedDate not supplied

On a hiding to nothing? Assessing the corporate governance of hospital and health services in New Zealand 1993-1998.

In New Zealand the governance of public sector hospital and health services has changed significantly over the past decade. For most of the century hospitals had been funded by central government grants but run by locally elected boards. In 1989 a reforming Labour government restructured health services along managerialist lines, including changing governance structures so that some area health board members were government appointments, with the balance elected by the community. More market oriented reform under a new National government abolished this arrangement and introduced (1993) a corporate approach to the management of hospitals and related services. The hospitals were established as limited liability companies under the Companies Act. This was an explicitly corporate model and, although there was some modification of arrangements following the election of a more politically moderate centre-right coalition government in 1996, the corporate model was largely retained. Although significant changes occurred again after the election of a Labour government in 1999, the corporate governance experience in New Zealand health services is one from which lessons can, nevertheless, be learnt. This paper examines aspects of the performance and process of corporate governance arrangements for public sector health services in New Zealand, 1993-1998.

Governing Board↗
PubMed2005

The impact of research governance in healthcare and higher education organizations.

AIM: This paper reports a study exploring the impact and implementation of research governance in the North West region of England. BACKGROUND: In 2001, the UK Government launched a framework to ensure the governance of research within the National Health Service. Whilst this framework was undoubtedly geared towards improving the standards and practice of research, concerns have been raised in the academic literature about the potentially negative impact on future research. METHODS: A mixed method approach, using questionnaires (n = 350), semi-structured interviews and focus groups with a volunteer sample, was used to explore research staff perspectives about research governance. Survey data were analysed using Microsoft Excel, and a thematic analysis was used to elicit themes from the semi-structured interviews. The study lasted for 12 months and used a range of study sites, giving insight into potentially different experiences or approaches to implementing the research governance framework. FINDINGS: Questionnaire data revealed a good level of awareness about the Research Governance Framework. However, a range of concerns was also raised, such as the increased workload associated with the research governance application process and lack of transparency about the process. Five themes emerged from the focus groups: control, epistemology, organizational issues, impact on teaching and learning, and ambiguity in the definitions of research and audit. CONCLUSIONS: Recommendations emerging from the study include the promotion of transparent research governance guidelines for practitioners, and the need for staff education about governance processes and greater parity between organizations in research governance processes.

England↗
PubMed2004

A case for government ownership of primary care services in New Zealand: weighing the arguments.

Primary care services provide continuing and coordinating care, cater to most health care needs, and serve as a point of first contact with the health system. This article addresses the issue of government ownership of primary care. Ownership confers governance responsibility (ultimate control) for an organization, and accountability for its actions. Primary care organizations can be classed as government owned and operated or privately owned and operated, the latter with or without community governance. The authors address two policy questions: Does the ownership form of a primary care organization matter? What ownership frameworks should be used to guide policymaking? Arguments for and against government ownership are examined from political and economic perspectives, informed by a governance framework. Government ownership of primary care may solve problems associated with private for-profit ownership that are related to lack of control of strategic assets, lack of direct political accountability, contracting, and market failure, but it may raise potential problems of lack of responsiveness to minority and local needs and capture by interest groups. In response to the problems associated with government ownership, community-governed private nonprofits have an essential role as a vehicle for indigenous self-determination, catering for minority populations, experimenting with policy options, and providing public goods particularly for minority populations. The authors argue that private organizations that lack community governance have a lesser role.

Community Participation↗
PubMed2004

Digital government and public health.

Digital government is typically defined as the production and delivery of information and services inside government and between government and the public using a range of information and communication technologies. Two types of government relationships with other entities are government-to-citizen and government-to-government relationships. Both offer opportunities and challenges. Assessment of a public health agency's readiness for digital government includes examination of technical, managerial, and political capabilities. Public health agencies are especially challenged by a lack of funding for technical infrastructure and expertise, by privacy and security issues, and by lack of Internet access for low-income and marginalized populations. Public health agencies understand the difficulties of working across agencies and levels of government, but the development of new, integrated e-programs will require more than technical change - it will require a profound change in paradigm.

Access to Information↗
PubMedDate not supplied

The development of English primary care group governance. A scenario analysis.

At present there is a policy vacuum about what English Primary Care Groups' (PCGs) governance will be when they develop into Primary Care Trusts (PCTs). Draft legislation leaves many options open, so PCT governance is likely to 'emerge' as PCTs are created. It also remains uncertain how general practitioners (GPs) will react to the formation of PCTs and how the UK government will then respond in turn. A scenario analysis suggests three possible lines of development. The base (likeliest) scenario predicts a mainly networked form of PCT governance. An alternative scenario is of PCT governance resembling the former National Health Service internal market. A third scenario predicts 'franchise model' PCTs employing some GPs and subcontracting others. To different degrees all three scenarios predict that PCTs will retain elements of networked governance. If it fails to make GPs as accountable to NHS management as the UK government wishes, networked governance may prove only a transitional stage before English PCTs adopt either quasi-market or hierarchical governance.

Attitude of Health Personnel↗
PubMed2006

Exploring the human resource implications of clinical governance.

In 1998, clinical governance was introduced in the National Health Service, UK (NHS) as a major policy initiative to improve the quality of clinical care. The implementation of clinical governance is crucially dependent on the skills, competencies and willingness of the NHS staff. In turn, clinical governance influences the way people work in health care organisations. Therefore, it is no surprise that the introduction of clinical governance has thrown-up new challenges for human resource management. However, what are these human resource management challenges under the clinical governance framework? The current literature on the subject provides no answer. This article attempts to fill this gap in the literature. A qualitative approach influenced by phenomenological case study approach has been adopted. A heterogeneous group of 33 persons identified through a purposive sampling procedure were interviewed using a semi-structured format. The results indicate that the staff members appreciate the crucial role of human resources management in the implementation of clinical governance. However, there is little evidence to suggest that senior management is paying attention to develop the human resources function around the clinical governance agenda. The seven major human resource implications of clinical governance that emerged from the data analysis are discussed. The author argues that a more proactive HR approach is needed to make clinical governance everyone's business in the NHS organisations.

Evidence-Based Medicine↗
PubMed2005

Governing genomics in the 21st century: between risk and uncertainty.

The paper reconstructs the governance of genomics by sketching the main features, modes of operation and tactics of the emerging genomics apparatus. Genomic governance in the 20th century is characterized by the simultaneous operation of a process of the stabilization of knowledge regimes, in particular via patenting. Furthermore, we observe a heterogenization and globalization of the actors and knowledge creating systems in genomics governance. A variety of different mechanisms and strategies of governance are mobilized simultaneously. The transition of governing via risk to governance by uncertainty is another important feature of contemporary genomics governance. The implications of these trends for the regulation of genomics are considerable and might lead to the emergence of new patterns and spaces of conflict and controversy. The governance of genomics in the 21st century could become a more complex challenge than currently anticipated by many policy makers and the scientific community.

Europe↗
PubMed2006

Government risk management priorities: a comparison of the preferences of Asian Indian Americans and other Americans.

A survey was conducted of approximately 200 Asian Indian Americans and 200 other residents of New Jersey in order to understand the risk management priorities that they want government to have. We found that Asian Indian Americans, especially younger women, focused on personal/family risks, such as alcohol and drug abuse, sexual abuse, and domestic violence. The New Jersey comparison group, in contrast, placed war/terrorism and loss of health care services and insurance at the top of their priorities for government. These results suggest stressful acculturation-related issues within the Asian Indian community. Both populations want more risk management from government than they believe government is currently providing. Respondents who wanted more from government tended to dread the risk, be fearful of the consequences, trust government, and have a feeling of personal efficacy. Within the Asian Indian American sample, wide variations were observed by language spoken at home and religious affiliation. Notably, Muslims and Hindi language speakers tended not to trust government and hence wanted less government involvement. This study supports our call for studies of recent migrant populations and Johnson's for testing ethnic identity and acculturation as factors in risk judgments.

Adolescent↗
PubMed1960

The role of government in medicine.

ON THE FUNDAMENTAL QUESTION OF HOW FAR A GOVERNMENT SHOULD BE INVOLVED IN HEALTH SERVICES, THE AUTHOR BELIEVES THESE THINGS CAN APPROPRIATELY BE SAID: The government should continue to assume complete control over public health measures, and public health officials could well be permitted to invade medical services insofar as is necessary to achieve public health ends. To assist in the production of medical personnel, it is also fitting for the government to provide for increased teaching facilities, higher salaries for teachers in the medical field and scholarships for worthy students. In the area of insurance and prepayment plans, a really intelligent supervision of such devices, with the exercise of no more arbitrary governmental power than is now used by the various other regulatory commissions, is a suitable governmental function. The government's buying policies for its wards, rather than providing direct medical services for them, should be encouraged. This would give the private practice of medicine a boost and would improve the quality of medical care. Government should encourage the regionalization of medical services with as much of the actual controls exercised at the local level as can be achieved. Private means should be utilized for the provision of these services and public means should be used for their payment when this is an obligation of the government. The problem of mass education in health matters should be tackled by government. It would be a fine thing if the medical profession and governmental agencies could agree upon delineation of their respective roles in the health field. Because further experimentation is needed before the ideal solution is found, both government and organized medicine should encourage the exploration of new approaches.

Government Agencies↗
PubMed2004

[Factors promoting follow-up services after medical examinations by municipal governments].

OBJECTIVE: All Japanese municipal governments have a responsibility to conduct a medical examination for their residents aged 40 or more under the Health Services for the Elderly Act since 1984. According to the results of the medical examination, municipal governments should give appropriate follow up services to all users. The objective of this study was to find the factors promoting follow up services after medical examinations conducted by municipal governments. SUBJECTS AND METHODS: Mailed questionnaire surveys on follow up services after medical examination were sent out to all 3,255 municipal governments in Japan. The 2,447 municipal governments that answered all items on the questionnaire were enrolled in this study. Follow-up services by municipal government for persons with abnormal findings at medical examinations included "Suggestion to have a more detailed examination", "Confirmation of having had a detailed examination", "Individual health consultation", and "Home visit for medical guidance". These follow-up services were analysed in terms of the number of public health nurses per population and whether a continuous data set was maintained for medical examinations. RESULTS: Follow-up services were conducted more frequently in municipalities that maintained continuous data sets of medical examination than those that did not. They were also carried out more frequently in municipalities with higher numbers of health visitors per population than in those with lower numbers. The percentage of municipal governments that maintained continuous data of medical examinations was higher among those that conducted group medical examinations than those that conducted individual medical examinations at local medical facilities. CONCLUSION: Follow-up services after medical examinations by municipal governments showed a significant relationship with maintenance of a continuous data set of medical examinations and the number of public health nurses.

Aged↗
PubMedDate not supplied

Hospital governing boards: a study of their effectiveness in relation to organizational performance.

This article describes the development and evolution of governing boards and summarizes critical findings from a research study on hospital governing boards. The purpose of the research was to examine factors that measure performance of governing boards and the relationship of governing board effectiveness to the organizational performance of hospitals. Board leaders from 64 nonprofit hospitals across the country were surveyed using the BSAQ tool, which measures board effectiveness in six areas of competency. Board competency scores of this group were compared with those of a previous group, which consisted of more than 300 nonprofit boards, and demonstrated significantly higher scores. A factor analysis conducted to compare the six competency factors between study groups revealed a strong single factor in this study. The factors that measure governing board performance were found to be consolidated into one single factor of collaborative board functioning consistent with emerging governance theory. This may support the concept of the importance of governing boards as collaborative, socially dynamic networks of leaders. The hospital performance was assessed using data from the nationally recognized program, Solucient's 100 Top Hospitals. The results demonstrate that higher performing boards did have better hospital performance in several dimensions, most notably in profitability and lower expenses. Lower expenses were related to higher scores for the BSAQ total score. Hospital profitability was positively correlated with all seven BSAQ scores. A more favorable Solucient ranking was related to hospitals that had a lower BSAQ political score. This was also found in a multiple regression model that predicted a favorable ranking when the BSAQ political score was lower. This may mean that these boards do what needs to be done to maintain excellent performance and do not let politics get in the way of their work. Although governance and its effect on hospital performance is a complex concept to study, this investigation yields findings of interest to leaders in the healthcare field.

Data Collection↗
PubMed2000

Shared governance--nurses making a difference.

AIM: This paper aims to describe how shared governance can be successfully integrated into existing management structures in a large medical directorate. It will show how the shared governance philosophy can lead to the creation of a culture where nurses feel important and valued and also consider its use as a foundation for the implementation of the nursing strategy. BACKGROUND: The hospital adopted shared governance in 1995 with the setting up of councils led by staff nurses. Shared governance advocates claim it broadens involvement of clinically-based nurses in the process of change through devolved decision-making thereby enhancing clinical practice and increasing staff moral and self-esteem. Key issues Shared governance is a cultural change that will develop the leadership and management skills of all grades of staff. Shared governance is not a quick fix for the profession; involvement of all staff needs time, persistence, determination and a strong commitment to training and development. CONCLUSION: The national nursing strategy puts nurses in a position to positively influence health care for the advantage of patients, however, for nurses to grasp this opportunity cultural change is required. This practical example of shared governance demonstrates how it can be used to create a proactive culture, focused on improving patient care. The nurturing and developing of clinically-based nurses provides them with the knowledge and skills to challenge the status quo and lead change. Thus, shared governance is an excellent foundation from which to develop the nursing strategy.

Decision Making, Organizational↗
PubMed2000

The origins and consequences of public trust in government: a time series analysis.

The study of citizens' trust in the national government has been primarily individual-level, cross-sectional analysis. In the current research, we develop a quarterly time series measure of trust in the U.S. national government from 1980 to 1997 and conduct the first multivariate time series examination of public trust in government. We find that negative perceptions of the economy, scandals associated with Congress, and increasing public concern about crime each lead to declining public trust in government. Declining trust in government in turn leads to less positive evaluations of Congress and reduced support for government action to address a range of domestic policy concerns. These results provide new evidence of the influence of public concern about crime and the centrality of Congress in understanding public evaluations of the national government and new evidence of how declining levels of trust in government may influence elections and domestic policy making.

Journal Article↗