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Elected Boards No Way to Run a Hospital

Cheryl Clark, for HealthLeaders Media, March 31, 2011

Is this any way to run a hospital with 161,000 patient encounters a year in a 500,000-population service area?

In 2009, another county Grand Jury with different members issued a similar report and concluded the board's "model of governance appears to be a hindrance." It suggested the board find another model of governance, which the board rejected.

Tri-City's seven board members are elected by residents of the district to four-year terms with no term limits, a situation that makes those members especially tough to train for proper governance, Kazemek says.

That's because they often "confuse their job and their role with representing their constituents, much like a politician. A board member's principal duty is to fall on the sword for the hospital, and not do anything to harm the hospital, not only financially, and for quality, but also reputationally."

Though there are many high-quality elected boards out there, he says, "Frankly, I don't recommend that [hospitals] have an elected board."

James Orlikoff, senior consultant to the Center for Healthcare Governance and National Advisor on Governance and Leadership of the American Hospital Association in Chicago, also knows about Tri-City's dysfunction. But these elected boards are often stuck, "because they can't select their members nor can they remove them. They're the worst model of management that exists, and they're impossible to change," he says. 

Of the 5,000 hospitals in the country, Orlikoff says, about 1,000 are public, district, or county hospitals and of those, 200 have elected boards. And for far too many, he says, board meetings often resemble "what amounts to a clown show."

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2 comments on "Elected Boards No Way to Run a Hospital"


Kevin T Kavanagh, MD (4/6/2011 at 12:26 PM)
The primary fiduciary responsibilty of a non-profit hospital board is NOT to the facility but to charitable purponses and the public. According to Lois Lerner, Director of the IRS Exempt Organization Division, for hospitals: "To qualify for tax-exemption, they must show that they provide benefit to a class of people, broad enough to benefit the community, and they must be operated to serve a public rather than a private interest." Source: Statement by Lois Lerner, Director of the IRS Exempt Organizations Division, on the IRS Report on Nonprofit Hospitals, at a Press Briefing, Feb. 12, 2009 http://www.irs.gov/pub/irs-tege/lernerstatement_hospitalproject_021209.pdf

Linda O (3/31/2011 at 4:15 PM)
Unless the courts step in, there will be no process for self-governance and self-correction. It's a shame to place the patients and employees at risk.