الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Healthcare sector is one of the largest sectors in the economy of any country across all other commodities. Such sector is funded by investors who do not want to lose money and wish to see their money worth in return. Health sector is composed of three main categories; non-profit whether public or non-governmental or for-profit private sector. A system for ensuring investors rights was needed.
Governance was proposed as a system that ensures and promotes accountability and responsibility toward shareholders or stakeholders according to hospitals type whether for profit or non-profit. Governance started first in the industry field then it was adopted to the healthcare field with the addition of a new type called clinical governance to ensure quality of healthcare provided to patients.
Governing boards are the central pillar of the governing system. They have the ultimate accountability and responsibility in any healthcare organization. They are composed of the top-level board members who has the responsibility of setting the organization mission, vision and of setting the policies of the healthcare institute. They have the power to hire or terminate the CEO of the hospital who is the only link between the board and the top-level management of the organization.
This study aims to:
1. To assess the governing board member composition and job description in for-profit and non-for-profit hospitals.
2. To determine the governing board member functions in for-profit and non-for-profit hospitals.
3. To evaluate the governing board member competencies and training in for-profit and non-for-profit hospitals.
The study was conducted in all hospitals of Alexandria, Egypt. Number of hospitals were as follows: 6 university hospitals; 15 ministry of health hospitals; four health insurance organization hospitals and 137 private hospitals. It was descriptive study, cross-sectional in design.
The study targeted hospitals’ Chief Executive Officer (CEO) of all hospitals in Alexandria. There was no sample size.The interview questionnaire was tested in 10 private hospitals.Ministry of health, Health insurance organization and university teaching hospital CEOs were interviewed each representing the whole sector in Alexandria as each of them are centralized boards. Of 137 private hospitals a total of 87 valid interview questionnaire schedules were conducted with a response rate of 63.5%. Several attempts were made for each non-respondent hospital with no response.
As regards data collection, data were collected through interview questionnaire with hospitals’ CEO across all hospitals of Alexandria, Egypt. Interviews were done using a predesigned structured interviewing questionnaire. The questionnaire was composed of the following sections;
First section is about hospital and CEO characteristics; ownership, number of beds and occupancy, educational background of the CEO (Chief Executive Officer), professional training of the CEO, the existence of a working board of directors and an internal audit department.
Second section is about board composition and job description; number of members, professional or technical expertise, representation of outsider members, representation of medical professionals, CEO duality (situation when the CEO also holds the position of the chairman of the board), remuneration, number of meetings for the previous year, executive committee (defined as a group that acts on behalf of the full governing board and is responsible for reporting to the full governing board), sub-committees (e.g. quality, audit and finance committees), internal document that outlines board proceedings (such as quorum requirements, roles, responsibilities, voting rules etc.), board members term length and succession plan, disclosure of conflicts of interest and board meetings agendas and minutes.
Third, Board functions; setting compensation for any hospital employee, monitoring the hospital’s financial performance (approves annual budgets for the hospital, follow up on utilization of budgeted funds, supervises proper collection of hospital revenue, develops new revenue sources and fundraise for the hospital), monitoring quality performance (monitors quality assurance activities and reviews and discusses quality of care reports at board meetings), appointment of the CEO, evaluating the performance of the board and the CEO and follow up of the strategic plan.
Final section is about board competencies and training; orientation program for new members, GB orientation manual, training or development plan for GB members, GB self-evaluation with board authorities.
The study reveals the following findings:
Part A: Socio-demographic, clinical and administrative characteristics
• Hospitals in Alexandria fall in 4 categories; Ministry of Health with 15 hospitals, Health Insurance Organization with 4 hospitals, University teaching with 6 hospitals and private hospitals making the main bulk of the hospitals under study with 87 hospitals as of December 2018.
• HIO hospitals size ranges from 150- 340 with a median of 245. MOH sizes range from 156-380 with median of 346. Teaching hospitals sizes range from 226-1642 with median of 934. Concerning private hospitals, board was present in about 82.75 % of hospitals with the oldest being established around 1970. In regard of occupancy rate of participating private hospitals in the study, it ranged from 35 to 80 % with mean of 61% while the hospital size ranged from 20 beds to 140 with mean of 50 beds and median of 80 beds.
• Around three quarters of the board directors were physicians (74.7%) with 56 out of 75 hospitals participating in the study followed by 8 dentists and 8 pharmacists forming 10.7% and 9.3% respectively. Four hospitals were run by engineers as board directors.
• Concerning the scientific level majority of board directors held a master degree (78.7%) followed by 12 and 6.7 % for diploma and doctorate levels respectively. The least percent was for bachelor degree with only 2 of study hospitals being run with directors holding only bachelor degree.
Part B: Board composition, characteristics and authorities
• Hospital size boards ranged from 2 to 20 members with a mean of 9 members with significant difference between different hospitals’ sizes and board size.
• Some of the members being from outside the hospital ranging from 1 to 6 members in some boards with mean of around 3 members.
• All hospital boards have physicians as members ranging from 2 to 13 with mean of around 6 physicians and there is significant different in number of medical personnel on board and different hospital sizes.
• All board members of participating hospitals in the study had an open term membership with just 0.29 having a succession plan policy.
• Regarding board members compensations for membership and meetings only .04 of the boards’ members were paid
• Concerning board meeting in the previous year, they ranged from 1 to 14 with mean of 6 meeting. The number of board members in each meeting differed with size with range of 3 to 20 members and mean of 7 members
• Each meeting lasted for about one and half hour with range from 1 to 3 hours.
• Only .04 of the boards had an internal document outlying roles and responsibilities.
• In regard to board committees and sub committees, only .12 of hospitals had an internal audit department and a slightly more .35 had an audit committee. None of the boards had an executive committee reporting to them. On another end, all boards under study had quality subcommittees while .35 and .42 had audit and finance committees respectively.
• With respect to board activities, only .14 were involved in employee’s compensation while .85 were involved in a corrective action needed with 98% of them taking the required action.
• While .98 of the boards monitored quality and patient safety only a quarter of them .25 had responsible committee in the hospital.
• A quarter of the boards 25.3% had an orientation program with significant difference according to hospital size. Only 9.3% of study hospitals having an orientation manual.
• About only 22.3% of the boards had training program with a little bit more than half of the boards having it actually implemented. In regard to training of board members, three quarters of the boards have some of the members trained with the rest of members needing training. About 17.3% of the board perceive that all members have an adequate training while on the other side 6.7% think that all members need training.
• In regard to board evaluation, about 82.7 of the boards had a policy for such and a little above two thirds 72% of them conducted a self-evaluation and only 36% having an effective process for non-performers removal.
• All of the boards had the authority to approve annual budget, strategic plans, hospital policies and procedures and CEO appointment approval. On the lesser side, only 12% of them could fundraise for hospitals being reserved mostly for public or nonprofit hospitals.
Based on the study findings, the following recommendations were suggested:
1- Research to correlate hospitals governing structure with their financial and quality outcomes.
2- Reversal overwhelming CEO duality in almost all hospitals with contrast to the recommended governing structure.
3- Development of internal document that defines board requirements such as quorum requirements, roles, responsibilities, voting rules etc. and helping in its development in requiring hospitals.
4- Adoption of CEO succession policy and preparing for his departure in advance.
5- Implementation of removal policy for board members.
6- Training of boards’ members across hospitals and development of training programs by the concerned institutes.
7- Workshops development about governance, its requirements and required structures, policies and procedures by the national accreditation system for current and upcoming hospitals’ directors.