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From the foreword:

Nonprofit healthcare organizations are not exempt from good governance. In fact, more today than ever, the hospitals and health care systems of this country must have the discipline and commitment to organize their governance structures and practices to provide forward-thinking leadership and stand up to scrutiny from any type of evaluation and review. As we move from “sick care” organizations to “health care” organizations with accountability for the health of the population of our communities from birth to end-of-life, the role of governance becomes even more critical.

Fourteen of the largest and most notable health care systems in this country have been included in a research study to examine their governance structures and practices in relation to nine benchmarks. The CEOs and board members of these organizations were interviewed about their structures, processes and cultures, and then compared to national best practices. The study also included close review of pertinent system documents.

This report is a must read for hospital and health care system CEOs and boards. It provides evidence-based outcomes that will assist an organization in advancing its governance practices. This study outlines critical success factors for governance structure and performance. It answers many questions that boards may be struggling with today and provides advancing actions. The research methodology is thorough and reliable with specific outcomes that provide high-performance opportunities.

Each CEO who participated in the research study has written about a best practice in his or her respective organization that advances governance responsibility. These insights add a personal dimension to this report.

Publication Date



Commonwealth Center for Governance Studies, Inc.


Lexington, KY




Governance, Nonprofit Health Systems, Public Health


Health Services Administration | Health Services Research | Public Health


This study of governance in a set of our nation’s largest nonprofit health systems was funded by major grants from Hospira, Inc., and Grant Thornton LLP. Vital grant support also was provided by Hall, Render, Killian, Heath, and Lyman, PC, Korn/Ferry International, and Sullivan, Cotter, and Associates. The research team is grateful to these five firms for their interest and support.

© Copyright 2012: Commonwealth Center for Governance Studies, Inc. This publication cannot be reproduced in any form without written permission.

Dr. Lawrence Prybil has granted permission for making this report available online here.

Governance in Large Nonprofit Health Systems: Current Profile and Emerging Patterns