Governance practices of regional hospitals in an integrated healthcare delivery system

Scope and method of study. The purpose of the study was to describe the governance practices of regional hospital boards of an integrated delivery system in advocating the healthcare needs of their local communities. Case study methodology included survey by questionnaire, in-depth interviews and content analysis. Board members and administrators, of eight regional hospitals described the recent affiliation of their hospital with an integrated delivery system and its impact on governance and community representation.; Findings and conclusions. Regional board members consider community representation a key role for which they are uniquely qualified. Local board members will fiercely protect community beneficial healthcare services. Rapid growth of an integrated delivery system may limit its ability to initiate integration strategies. Integration opportunities are best initiated early in the affiliation relationship. Regional board members find healthcare complex and confusing. Integrated delivery systems will face integration difficulties unless regional hospital boards engage in systems thinking. Involvement in integrated delivery system governance processes promotes systems thinking on the part of regional board members. Community surveys enhance community representation efforts. System bureaucracy minimizes the likelihood of successful system integration. Board development for regional hospital board members on board roles, and responsibilities should occur following system affiliation. Development of a joint regional board at the system level may facilitate the transition from institutional governance to system governance. Without community representation processes, system boards may lose touch with the unique circumstances and needs of system regional hospitals. Study results suggest that the relationship of the regional hospital to its community is a key factor in successful integrated healthcare delivery system integration, and that community representation in governance be carefully nurtured.