Restoring Governance Alignment within a Health System

There are two great forces in the universe: momentum and inertia. Momentum causes difficulty in changing the direction and speed of an object once in motion. Inertia causes difficulty in starting motion of an object that is at rest.

Ironically, in opposition these two forces can keep health system boards from being as fully aligned as they could and should be. How? Since most systems were formed via mergers, acquisitions, or other consolidations of existing hospitals—each of which had a board with its own understanding of its own role and function—misalignment often reflects the existing momentum of local boards plus inertia at the parent level to assume responsibilities in critical areas such as quality, strategy, credentialing standards, and occasionally even finance. Numerous articles have been published on addressing the root causes of parent–subsidiary dysfunction1 and on the future of hospital subsidiary boards.2 This article focuses on common examples of governance misalignment that have created barriers to high system performance. We also include a recent case study that highlights what one regional health system did to realign its governance model and how it learned to overcome misdirected momentum and inertia.

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