Kovner A R
Inquiry. 1981 Fall;18(3):255-65.
The organizational structure of nonprofit hospitals has remained fixed while hospital technology and financing have changed. Caught between competitive pressures from other organizations not subject to the same government regulation to contain costs and assure quality, and physician resistance to organizational change, hospital boards lack the capacity to make effective and timely decisions to retain market share. Governing structure will have to change for nonprofit hospitals to sustain growth and to achieve adequate standards of cost containment, quality assurance, and patient service. Accountability for hospital performance should be maintained through increased control of the governing board by physicians and managers. The board and medical official should agree on the nature of the latter's accountability for departmental or committee performance. The board should hold medical officials so accountable. If regulators, trustees, physicians, and managers are genuinely interested in sustaining the nonprofit hospital's share of the market, they must pay more attention to the structure and function of hospital governance, so that boards can more effectively respond to market opportunities, contain costs, and assure quality.
非营利性医院的组织结构保持不变，而医院技术和融资方式却已发生变化。一方面，非营利性医院受到来自其他组织的竞争压力，这些组织不受相同的政府成本控制和质量保证监管，另一方面，医生抵制组织变革，在此双重压力下，医院董事会缺乏做出有效且及时决策以保持市场份额的能力。非营利性医院若要实现持续增长并达到成本控制、质量保证和患者服务的适当标准，其治理结构必须做出改变。应通过医生和管理人员对董事会的更多控制来维持对医院绩效的问责制。董事会和医疗官员应就后者对部门或委员会绩效的问责性质达成一致。董事会应要求医疗官员承担如此的问责。如果监管机构、受托人、医生和管理人员真正有兴趣维持非营利性医院的市场份额，他们必须更加关注医院治理的结构和功能，以便董事会能够更有效地应对市场机遇、控制成本并保证质量。
