Really governing: what type of work should boards be doing?

Effectiveness is generally defined as "doing the right things." To be effective, boards of health systems and hospitals must have a clear, precise, and shared image of the type of work they should be doing to really govern their organizations. This article forwards a paradigm of board work--the five ultimate responsibilities and three core roles of governance. The paradigm is then employed to discuss the division of responsibilities and roles among boards and their standing committees, and superordinate and subordinate boards in tiered governance situations typical of many multifacility and integrated health care delivery systems.