Navigating the system governance maze

Health care system governance today is a complex maze of concerns that assume a unique character in Catholic-sponsored multi-institutional systems. Most Catholic health care systems began with a common sponsor or mission and several shared services and gradually moved from separately incorporated entities to a system with few centralized operating functions but a governing body between the local facilities and the sponsoring religious institute. The next step was development of a managed system with consolidated services and centralized decision making. Now, many systems are attempting the most important and difficult effort--systemwide strategic planning. The phases described have required a rethinking of governance structures, and conflicts often arise during restructuring. Such turmoil requires many Catholic health care systems to develop a clearer sense of direction and purpose. To achieve their objectives, system leaders can use a governance compass that has five key points: Information. Boards must determine what they need to know, where to secure this information, and what form the information should take. Agenda. Boards must make reflective and intentional use of their agenda by reviewing and categorizing agenda items discussed in the past 12 months and establishing an agenda plan for the next 12 months. Structural mechanisms. Boards must decide structural issues such as relationships between system board and local boards, sizes of boards, and kinds of committees needed. Culture. Boards should reflect on their culture--values and traditions that have characterized them in the past--to assess whether changes are needed to strengthen or improve the culture.(ABSTRACT TRUNCATED AT 250 WORDS)