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Biennial Survey Reports

The Governance Institute surveys all non-profit, acute care hospitals and health systems every other year to take a deep look at how their boards are structured, what practices boards have adopted to fulfill their fiduciary duties and core responsibilities, and how well boards are performing in these oversight areas. This is the only survey of its kind, published in a detailed report of results and includes a list of recommended practices that is among the industry standard.

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The Governance Evolution: Meeting New Industry Demands

Available for Purchase

2017 Biennial Survey of Hospitals and Healthcare Systems

As a nation, we are still struggling to come to terms with the fact that our healthcare system underperforms and still costs much more than other countries. Hospital and health system boards are at the top of the care provider leadership hierarchy, and therefore positioned to lead the charge in turning the industry around. This year’s survey sought to uncover how board structure and culture are continuing to reflect the industry’s movement towards value and population health across the continuum, and away from hospital-centric organizations.


21st-Century Care Delivery: Governing in the New Healthcare Industry

2015 Biennial Survey of Hospitals and Healthcare Systems

As changes in delivery move more and more care out of hospitals, governing boards are developing new structures, adopting new strategies, and building new cultures to respond to the need for high-performance and quality in all community settings. The 2015 survey sought information about how board structure, culture, and practices are continuing to evolve, representing a 21st-century delivery model.


Governing the Value Journey: A Profile of Structure, Culture, and Practices of Boards in Transition

2013 Biennial Survey of Hospitals and Healthcare Systems

Since we last reported on governance structure and practices in 2011, the Supreme Court upheld the majority of the Patient Protection and Affordable Care Act, clearing the way for implementation. Given that providers are now moving slowly towards value-based payment models and more hospitals are becoming affiliated with systems, this year’s survey sought information about how board structure and practices may be changing to prepare for a new healthcare business model.


Dynamic Governance: An Analysis of Board Structure and Practices in a Shifting Industry

2011 Biennial Survey of Hospitals and Healthcare Systems

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.


Governance Structure and Practices: Results, Analysis, and Evaluation

2009 Biennial Survey of Hospitals and Healthcare Systems

As governance becomes more complex, the list of fundamental practices increases in order to help boards frame their work more effectively and streamline their decision making. Governance structures, processes, and practices continue to change to meet the demands of the organization, the community, and the legal and regulatory environment. The Governance Institute surveys U.S. not-for-profit hospitals every other year and, although the framework of the surveys remains similar, the information sought varies from year to year. This year’s survey is longer than in previous years, with more governance structure and more governance practice questions.


The Medical Staff: A Foundational Report

2008 Biennial Survey of Medical Staff Structure & Practices

In order to determine the current structure and practice of medical staffs, we conducted a survey of 4,954 non-profit and for-profit acute care hospitals from August through November 2008. The survey resulted from expert consultation with Medical Leadership Institute advisors Hugh P. Greeley and Todd Sagin, M.D., J.D. Because this is the first survey of its kind, it was designed to cover issues of both depth and breadth—from composition of the medical staff to specific quality/peer review practices; from medical staff officer terms to the specific make-up of a fair hearing panel; from medical staff dues to how the medical staff votes on changes to bylaws; and more.