Hospital governing boards

Abstract

Few modern enterprises are more complex than the hospitals in which many emergency physicians practice. As competition increases in medicine and the criteria for reimbursement become stringent, marked changes will continue to occur in hospital structure and function. It is, therefore, necessary for the hospital based practitioner to understand the main player in determining the hospital’s organization-the hospital governing board. Variously called a Board of Trustees, Board of Governors, Board of Directors, or Commissioners, depending on the ownership and control of the hospital, this governing board “has the ultimate authority and responsibility for patient care and overall quality of service in the hospital.“’ Sitting at the apex of the organizational chart in every hospital, the members of this body hold the hospital and its resources in trust for the community. The members of this board have been charged legally, as in the Darling case,2 and traditionally with the ultimate responsibility and control for the operation of the hospital. This includes the standards of patient care, the conduct of hospital services and responsibility to the community.3.4 This sense of responsibility has been heightened by the increasing concern regarding the members’ legal liability-which has paralleled the medical malpractice crisis.5,6 There is, however, less than complete uniformity on many of the aspects of the board, including its composition, membership selection and continuity, organization, and tasks. Even where there is agreement, reality frequently does not follow the ideal.