The Governance Institute surveys U.S. not-for-profit hospitals and health systems on governance structure and board activities every other year. Since we last reported on governance structure and practices in 2009, the healthcare industry looks drastically different, due to the passage of the Patient Protection and Affordable Care Act, an increase in hospital mergers and consolidations, and the nation’s continued struggle to recover from the Great Recession. This year’s survey included new questions relating to both governance structure and practices, in an effort to reveal subtle shifts connected to how organizations may be beginning to respond to these unprecedented marketplace dynamics.

The report is organized into two sections. The first section of the report focuses on governance structure and offers comparisons with previous reporting years, as well as notable variations by organization type. The second section reports prevalence of adoption of recommended governance practices, and overall board performance for each area of board oversight responsibility. This year, we increased the number of recommended practices to 95. This year’s report also includes commentaries on the survey results from our governance advisors Don Seymour, Roger Witalis, Pam Knecht, and Ed Kazemek, as well as Jim Rice, Larry Gage, David Nash, and Ken Kaufman.

Also included are three appendices. These include 1) results by frequency (percentages) for governance structure, by organization type, AHA designation, and bed size; 2) results by frequency for governance practices, by organization type; and 3) a table of all governance practices, using composite scores to determine the rate of adoption of the practices; this table highlights the most and least observed practices and compares the scores to the 2009 results.