Each year public hospitals provide care for more than ten million patients across the United States. As well as being major training sites for all health care professions, they are often the safety-net providers for their communities, and are strongly affected by economic downturns that swell the rolls of the uninsured.

This paper focuses on whether a public hospital's governance structure helps or hinders its ability to respond competitively to changes in the health care environment. The authors analyzed 19 public hospitals in California, while also investigating the dynamics associated with governance changes at three high-profile public hospitals located elsewhere in the country.

The study found no apparent relationship between a public hospital's governance structure and key institutional characteristics, such as its size, patient volumes (discharges and visits), or operating margin. Rather than an "optimal" model of governance, the results suggest that the relative effectiveness of different models depends on the environment in which the hospital operates and the abilities of key leadership. What's more, the very process of restructuring may provide opportunities for improving the speed and quality of a hospital's decision-making.

The complete paper is available under Document Downloads.