The Evolving Accountability of Nonprofit Health System Boards

While nonprofit health care boards exist to serve community stakeholders, the nature of their accountabilities and the mechanisms for demonstrating fulfillment of them are not always completely clear or understood by every board member.

In The Evolving Accountability of Nonprofit Health System Boards, authors Larry Prybil, Ken Ackerman, Doug Hastings and John King, explore the multiple accountabilities of these boards in a changing environment, characterized by increased scrutiny and public demands for higher levels of health care cost, quality and safety performance.

The authors review categories of accountability and provide examples of mandated and voluntary accountabilities, largely to outside organizations and entities, that systems and their boards are responsible for fulfilling.  They contend that these accountabilities “collectively comprise an uncoordinated mosaic of requirements and reports, the overall impact of which boards themselves and certainly the communities they serve may be largely unaware.” Yet, they say, boards must understand this web of accountabilities in order to be effective stewards of organizational resources.

The authors also discuss a broader accountability that nonprofit systems and their boards have to the communities they serve, and suggest that mechanisms for demonstrating fulfillment of this accountability are underdeveloped.

This publication includes questions that can guide board discussion of accountability to stakeholders and specifically to the communities served by their health care systems.  It also includes a Model Policy Statement on Nonprofit Health System Board Accountability that clearly and concisely delineates accountabilities that these boards have to the community and other stakeholders.

As boards focus on transforming their governance practices to guide a transforming health care system, this publication offers an opportunity for them to step back and reflect on the fundamental purpose of governance and how they can ensure that this purpose is understood and fulfilled.

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