Hospital governance must take new directions if it is to meet the demands of a rapidly changing health care environment. Board members must increasingly become risk takers, strategic directors, evaluators, and mentors. Lessons from other industries in regard to risk taking, use of expertise, and streamlining decision making must be adapted to meet hospital needs. Recent data indicate that these needs still may differ by hospital ownership despite a convergence in investor-owned and not-for-profit corporate structures. The effectiveness of hospital boards in the future will depend on their ability to: 1. manage a diverse group of stakeholders, 2. involve physicians in the management and governance process, 3. meet the governance needs of multi-institutional systems and hospital restructuring, 4. meet the challenges of vertical integration and diversification, and 5. understand strategy formulation and implementation as interrelated and interdependent processes.
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