Refinement of boards' role required.

The governing board's role in health care is not changing, but new competitive forces necessitate a refinement of the board's approach to fulfilling its role. In a free-standing, community, not-for-profit hospital, the board functions as though it were the "owner." Although it does not truly own the facility in the legal sense, the board does have legal, fiduciary, and financial responsibilities conferred on it by the state. In a religious-sponsored facility, the board fulfills these same obligations on behalf of the sponsoring institute, subject to the institute's reserved powers. In multi-institutional systems, the hospital board's power and authority depend on the role granted it by the system. Boards in all types of facilities are currently faced with the following challenges: Fulfilling their basic responsibilities, such as legal requirements, financial duties, and obligations for the quality of care. Encouraging management and the board itself to "think strategically" in attacking new competitive market forces while protecting the organization's traditional mission and values. Assessing recommended strategies in light of consequences if constituencies think the organization is abandoning its commitments. Boards can take several steps to match their mode of operation with the challenges of the new environment. Boards must rededicate themselves to the hospital's mission. Trustees must expand their understanding of health care trends and issues and their effect on the organization. Boards must evaluate and help strengthen management's performance, rather than acting as a "watchdog" in an adversarial position. Boards must think strategically, rather than focusing solely on operational details. Boards must evaluate the methods they use for conducting business.