Formal relationships among governing boards, CEOs, and medical staffs in independent and system hospitals

This study examines the impact of hospital participation in multi-institutional arrangements on formal relationships between hospital governing boards and chief executive officers (CEOs) and between governing boards and hospital medical staffs. Hypotheses are derived from Mintzberg's general theory of organizational design and are tested using combined data from three American Hospital Association Surveys of nonfederal, short-term hospitals. Analysis results provide considerable support for the study hypotheses. CEOs were found in general to have more formal influence in decisionmaking but also were more likely to be held accountable for performance standards in those hospitals that are part of multi-institutional arrangements. In addition, analyses using both 1976 and 1982 survey data indicate that hospital participation in multi-institutional arrangements is associated with lower levels of formal involvement of the medical staff in institutional decisionmaking. Relationships, for the most part, remain unchanged after the introduction of statistical controls for hospital size. One important issue raised by these findings is the possible impact on hospital performance of less participation by medical staff in the governance of hospitals whose boards are either responsible for multiple hospitals or accountable to higher organizational authority.