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Medical Care Research and Review
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Changes in the Monitoring and Oversight Practices of Not-for-Profit Hospital Governing Boards 1989-2005

Evidence From Three National Surveys

Jeffrey A. Alexander

University of Michigan, Ann Arbor

Shoou-Yih D. Lee

University of North Carolina at Chapel Hill

Virginia Wang

University of North Carolina at Chapel Hill

Frances S. Margolin

Health Research & Educational Trust, Chicago, IL

Despite the legal and practical importance of monitoring and oversight of management by hospital governing boards, there is little empirical evidence of how hospital boards fulfill these roles and the extent to which these practices have changed over time. We utilize data from three national surveys of hospital governance to examine how oversight and monitoring practices in public and private not-for-profit (NFP) hospital boards have changed over time. Findings suggest that board relations with CEOs in NFP hospitals display important but potentially contradictory patterns. On the one hand, NFP hospital boards appear to be exercising more stringent oversight of management and hospital performance. On the other hand, management is more actively involved with governance matters with less separation of board and management. This general pattern varies by the dimension of oversight and monitoring practice and by specific characteristics of NFP hospitals.

Key Words: governance • nonprofit hospitals • governing boards • management oversight • accountability

This version was published on April 1, 2009

Medical Care Research and Review, Vol. 66, No. 2, 181-196 (2009)
DOI: 10.1177/1077558708326527
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