Olena Mazurenko, MD, PhD, is Assistant Professor, Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis. E-mail:
Health Care Manage Rev. 2019 Jul/Sep;44(3):263-273. doi: 10.1097/HMR.0000000000000165.
In U.S. hospitals, boards of directors (BODs) have numerous governance responsibilities including overseeing hospital activities and guiding strategic decisions. BODs can help hospitals adapt to changes in their markets including those stemming from a shift from fee-for-service to value-based purchasing. The recent increase in market turbulence for hospitals has brought renewed attention to the work of BODs.
The aim of the study was to examine trends in hospital BOD structure and activities and determine whether these changes are commensurate with approaches designed to respond to market pressures.
METHODOLOGY/APPROACH: We examined hospital level data from The Governance Institute Survey (2009, 2011, 2013, and 2015) and corresponding years of the American Hospital Association Annual Survey in a pooled, cross-sectional design. We conducted individual multivariate models with adjustments for hospital and market characteristics, comparing the changes in BOD structures, demographics, and activities over time.
The sample included 1,811 hospital-year observations, including 682 unique facilities. We found that BODs in 2015 had less internal management (β = -2.25, p < .001) and fewer employed and nonemployed physicians (β = -8.28, p < .001) involved on the BOD. Moreover, compared to 2009, racial and ethnic minorities (2013 β = 2.88, p < .001) and women (2013 β = 1.60, p = .045; 2015 β = 2.06, p = .049) on BODs increased over time. In addition, BODs were significantly less likely to spend time on the following activities in 2015, as compared to 2009: discussing strategy and setting policy (β = -5.46, p = .002); receiving reports from management, board committees, and subsidiaries (β = -29.04, p < .001); and educating board members (β = -4.21, p < .001). Finally, BODs had no changes in the type of committees reported over time.
Our results indicate that hospital BODs deploy various strategies to adapt to current market trends. Hospital decision-makers should be aware of the potential effects of board structure on organization's position in the changing health care market.
在美国的医院中，董事会（BOD）承担着众多治理职责，包括监督医院的活动和指导战略决策。BOD 可以帮助医院适应市场变化，包括从按服务收费向基于价值的购买转变带来的变化。最近医院市场动荡加剧，重新引起了人们对 BOD 工作的关注。
本研究旨在考察医院 BOD 结构和活动的趋势，并确定这些变化是否与应对市场压力的方法相适应。
方法/方法：我们采用了汇集的、横截面设计，对治理研究所调查（2009 年、2011 年、2013 年和 2015 年）和相应年份的美国医院协会年度调查中的医院层面数据进行了研究。我们对医院和市场特征进行了个体多元模型调整，比较了 BOD 结构、人口统计学和活动随时间的变化。
该样本包括 1811 个医院年观测值，其中包括 682 个独特的设施。我们发现，2015 年的 BOD 内部管理较少（β=-2.25，p<.001），参与 BOD 的雇佣和非雇佣医生也较少（β=-8.28，p<.001）。此外，与 2009 年相比，2013 年少数民族（β=2.88，p<.001）和女性（2013 年β=1.60，p=0.045；2015 年β=2.06，p=0.049）在 BOD 中的比例随着时间的推移而增加。此外，与 2009 年相比，2015 年 BOD 用于以下活动的时间明显减少：讨论战略和制定政策（β=-5.46，p=0.002）；从管理层、董事会委员会和子公司接收报告（β=-29.04，p<.001）；和教育董事会成员（β=-4.21，p<.001）。最后，BOD 报告的委员会类型在报告期间没有变化。
我们的研究结果表明，医院 BOD 采用了各种策略来适应当前的市场趋势。医院决策者应该意识到董事会结构对组织在不断变化的医疗保健市场中的地位的潜在影响。
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