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2019 National Health Care Governance Survey Report

A new AHA report provides a wealth of benchmarking data for hospital boards, answering questions about typical size of the hospital board, board diversity, term limits, board selection, orientation/education, evaluation, time commitment, and more.

The report includes data and commentary organized by these categories:

  • Board composition
  • Board structure and support
  • Board practices
  • Performance oversight
  • Board culture

Source: National health care governance survey report. American Hospital Association, 2019. https://trustees.aha.org/system/files/media/file/2019/06/aha-2019-governance-survey-report_v8-final.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org


GOVERNANCE: How many members on governing board?

The average size of a health care governing board is 13 to 16 members, according to a 2015 survey conducted by The Governance Institute.  This article, written by a governance consultant, describes the traditional model for a hospital board – the community board model.  Reasons why health systems are exploring other models are discussed.  These other models include:

  • Mirror boards
  • Community board at the parent company level only
  • Board of experts
  • Committees only at the system board level
  • CEOs of subsidiary hospitals report directly to system CEO

Source: Stout, L.R. (2017, March-April). Breaking free from traditional models. Healthcare Executive, 32(2), 72-75.  Click here for publisher’s website: http://ache.org/HEOnline/digital/heonline_index.cfm  Posted by AHA Resource Center (312) 422-2050 rc@aha.org


How many hospitals have nurses on the governing board?

I found this intriguing table tucked away in an article that compared responses of nurse executives to surveys taken in 2011 and 2013.  The question was whether the institution has nurses on the governing board.  There is no aggregate statistic for hospitals as a group, but here are the responses for urban versus rural hospitals:


  • 65 percent yes (rural hospitals)
  • 62 percent yes (urban hospitals)

How do these percentages resonate with your experience at your hospital?

Source: Pittman, P., Bass, E., and Hargraves, J. (2015, Feb.). The future of nursing: Monitoring the progress of recommended change in hospitals, nurse-led clinics, and home health and hospice agencies. JONA. The Journal of Nursing Administration, 45(2), 93-99.  Click here to access publisher’s website:

http://journals.lww.com/jonajournal/Citation/2015/02000/The_Future_of_Nursing__Monitoring_the_Progress_of.8.aspx    Posted by AHA Resource Center (312) 422-2050, rc@aha.org

National Health Care Governance Survey – Benchmark Results

The average hospital board size is 12, while the average system headquarters board is sized at 16. Three quarters of hospital boards include a physician, and one third include a nurse. Boards met an average nine times annually. Trustee compensation was offered by 12% of hospital/system boards. These are some of the findings from a new national health care governance survey recently released by the American Hospital Association’s Center for Healthcare Governance.

The report looks at hospital and health system governing board practices in these areas:

  • Board composition size and diversity
  • Board structure, including term limits, meeting frequency, board compensation, and committees
  • Board selection
  • Board orientation and education
  • Board evaluation
  • CEO performance and compensation
  • Quality and strategy oversight
  • Internal and external stakeholders, covering physician and clinical staff alignment, understanding community health needs, and the IRS Form 990
  • Board culture, such as executive sessions, meeting disccussion, and electronic board portals
  • Readiness for health care transformation

Source: 2014 National health care governance survey report. Center for Healthcare Governance, 2014. http://www.americangovernance.com/resources/reports/governance-reports/2014/

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Diversity and Disparities: a Benchmark Study of U.S. Hospitals in 2013

Three key ways hospitals and health systems can address disparities in health care are:

  1. Increase the collection and use of race, ethnicity and language preference [REAL] data to identify where disparities exist
  2. Increase cultural competency training to ensure caregivers and other staff have a deeper understanding of diverse patients and their individual needs
  3. Increase leadership and governance diversity

A new survey report looks at what hospitals are doing on these 3 fronts, learning more about the strategies used and providing benchmarks for gauging hospital progress.

Top line survey results found:

  • Most hospitals are actively collecting patient demographic data — 97% collect data on race, 94% on ethnicity, and 95% on primary language.
  • 86% of hospitals provide cultural competency training to clinical staff, while nearly 65% require all employees to attend diversity training.
  • Minorities comprise 14% of hospital trustees, 12% of executive leadership, and 17% of first- and mid-management positions.
  • Nearly a third of patients are from a minority group.

Meanwhile, a new report from the Robert Wood Johnson Foundation and the Urban Institute compares how the U.S. and European Union approach eliminating health disparities. One key difference: the U.S. has focused primarily on racial/ethnic disparities rather than economic inequities, although they are often intertwined.


Diversity and disparities: a benchmark study of U.S. hospitals in 2013. Institute for Diversity in Health Management; Health Research & Educational Trust, 2014. http://www.diversityconnection.org/diversityconnection/leadership-conferences/diversity_disparities_Benchmark_study_hospitals_2013.pdf

Docteur E; Berenson RA. In pursuit of health equity: comparing U.S. and EU approaches to eliminating disparities. Robert Wood Johnson Foundation; Urban Institute, June 2014. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf414060

Related sources:

Earlier benchmarking surveys: 2011 2009

Equity of Care web site, a collaboration of the American College of Healthcare Executives, American Hospital Association, Association of American Medical Colleges, Catholic Health Association of the United States, and America’s Essential Hospitals. Accessed June 25 at http://www.equityofcare.org/

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

CORPORATE CULTURE: Guide for organizational ethics

“Over time, an organization may lose its soul.”  That grabs your attention.  This article presents and describes an organizational ethics guide developed by Catholic Health East to help avoid that kind of erosion of mission and values.  The guide is short and consists of the following three categories of questions that can be applied to value-based decision-making:

  1. Significant organizational decisions
  2. How does ethical review of policy work?
  3. Considering organizational culture and behavior

How several hospitals in the CHE system have formalized this process through the establishment of board-management committees is also discussed briefly.

Source: Sanders, A.  Sustaining a commitment to mission and core values.  Health Progress;94(3):72-77, May-June 2013.  Click here for publisher’s website: http://www.chausa.org/HP/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Practice Benchmarks on Non-profit Health System Governing Boards

A study of the governance structure of the 14 of the largest nonprofit health systems in the US is detailed in this new report. With an eye toward ongoing improvement, the report provides benchmarking data on governance practices in the following areas:

  • Board structure, including consecutive term limits, voting board member limits, board size, board composition, board committees and executive committees, and perceived effectiveness of committees
  • Board processes, covering board accountability, board chair-CEO relationships, board and CEO evaluation processes, succession planning, boards role in patient care quality and in community benefit, and allocation of board time and effort
  • Board culture, such as  approach to decision-making, board development, senior staff support for the board, and executive sessions

Emerging governance patterns are identified. The study collectively scores systems [not by name] on effective governance practices and correlates that with overall system patient care performance, based on Thomson Reuters [now Truven] 100 Top Hospitals methodology. While not the primary focus of the study, the researchers found a correlation between effective  governance scores and some patient care measures, but not with the overall aggregate patient care performance measures used. An appendix to the report highlights a selected governance feature each participating system provided.

The systems that participated in the study were:

  1. Adventist Health System Sunbelt Healthcare
  2. Ascension Health
  3. Banner Health
  4. Carolinas HealthCare System
  5. Catholic Health East
  6. Catholic Health Initiatives
  7. Catholic Health Partners
  8. Christus Health
  9. Kaiser Foundation Hospitals and Health Plan
  10. Mayo Clinic
  11. Mercy Health
  12. Providence Health & Services
  13. Sutter Health
  14. Trinity Health

Source: Prybil L and others. Governance in large nonprofit health systems: current profile and emerging patterns. Commonwealth Center for Governance Studies, 2012. http://www.mc.uky.edu/publichealth/documents/Governance_booklet_FINAL.pdf

Related sources:

Foster D. Hospital system membership and performance; top 100 hospitals research. Truven Health Analytics, May 2012. http://www.100tophospitals.com/assets/health_system_hospitals_perform_better.pdf

Prybil L and others. Governance in high-performing community health systems; a report on trustee and CEO views. Grant Thornton, 2009. http://www.nonprofithealthcare.org/resources/GovernanceInHigh-PerformingCommunityHealthSystems.pdf

2011 AHA health care governance survey report. AHA Center for Healthcare Governance, 2012. Available for sale at http://ams.aha.org/eweb/?ahabu=AMERICANGOVERNANCE

Dynamic governance: an analysis of board structure and practices in a shifting Industry.  2011 biennial survey of hospitals and healthcare systems.  Governance Institute, Fall 2011. Available for sale at http://www.governanceinstitute.com/ResearchPublications/ResourceLibrary/tabid/185/ProductID/1199/CategoryID/3/List/1/Level/a/Default.aspx?

Posted by AHA Resource Center, (312) 422.2050, rc@aha.org

Survey Results: Hospital Readiness for ACOs

The Health Research and Educational Trust, an affiliate of the American Hospital Association, conducted a survey of US hospitals in 2011 to determine their readiness for the development of accountable care organizations. A small percentage of hospitals was currently participating in an ACO [3%] or preparing to participate [10%]. Three-quarters of hospitals were not exploring the ACO model at the time.

The report also discusses the following, based on survey findings on hospital ACO activity:

  • ACO governance structure, including physician relationships
  • Legal structure of ACOs, including risk management ability and arrangements
  • ACO payment models, including capitation and pursuit of bundled payments
  • Partnerships and ability to provide primary, acute, and post-acute care
  • Care management, including patient population identification and assignment, population management, care coordination and transitions, and clinical information exchange
  • Performance reporting and quality improvement
  • Challenges and perceived barriers

Appended to the report is an ACO readiness assessment checklist to help organizations determine their progress on the ACO development journey.

Source: Hospital readiness for population-based accountable care. Health Research and Educational Trust, May 2012. http://www.hpoe.org/resources-and-tools/resources/Accountable_Care.pdf

Related source: Audet AJ and others. Hospitals on the path to accountable care: highlights from a 2011 national survey of hospital readiness to participate in an accountable care organization. Commonwealth Fund Issue Brief, vol. 22, Aug. 2012. http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/Aug/Hospitals-on-the-Path-to-Accountable-Care.aspx

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

New biennual survey of hospital governing boards available

The Governance Institute (www.governanceinstitute.com) has released the 2011 Biennial Survey of Hospitals and Healthcare Systems.  This is the first survey to look at governance structures in the post-Patient Protection and Affordable Care Act era, and new questions have been included to detect how hospitals are adapting to the shifting landscape.

As in previous years, the report is divided into two major sections – board structure and recommended practices adoption.  The 2011 survey includes a look at the prevalence of 95 recommended practices, several of which are appearing for the first time.  Commentaries on the survey results by recognized authorities – Don Seymour, Ed Kazemek, Ken Kaufman, and others – round out report.   

The report is available to Governance Institute members on the website; nonmembers may purchase the report.

Governance Institute.  Dynamic Governance: An Analysis of Board Structure and Practices in a Shifting Industry.  2011 Biennial Survey of Hospitals and Healthcare Systems.  Fall 2011.  http://www.governanceinstitute.com/ResearchPublications/ResourceLibrary/tabid/185/CategoryID/3/List/1/Level/a/ProductID/1199/Default.aspx?SortField=DateCreated+DESC%2cDateCreated+DESC

Reform requires shift in board approach to quality oversight

Under the new health care reform legislation, clinical integration – the seamless interplay of facilities, professionals, services, and health information – is key, underscoring the importance of systems-based health care.  Hospital boards, with their oversight responsibility for quality of care, must begin to shift their focus from monitoring individual providers or operating units to ensuring that the entire service continuum is operating in top form.  The price for not doing so will be felt as reimbursement penalties for under-performance come online over the course of the next few years.

The American Health Lawyers Association’s Quality in Action Task Force has published some preliminary work from a forthcoming toolkit that covers the following areas:

  • board leadership
  • collection and use of quality data
  • assessing providers’ performance
  • quality oversight outside the hospital

The article also provides some overview of legal and operational challenges

  • integrating the medical and executive functions
  • legal liability for restricting providers’ practice
  • peer review

The proposed toolkit, Quality in Action: Paradigm for a Hospital Board-Driven Quality Program, will be available through AHLA’s Public Information Series at http://www.healthlawyers.org/Resources/PI/InfoSeries/Pages/default.aspx.


Source: Belmont, Elisabeth, and others.  A new quality compass: hospital boards’ increased role under the Affordable Care Act.  Health Affairs.  30(7):1282-1289, July 2011.   http://content.healthaffairs.org/content/30/7/1282.abstract (subscription or purchase access only)