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Objective: The reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be 'bottom up' with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged., Design: Detailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures., Setting/participants: In phase 1 of the study (January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings., Results: Our study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs., Conclusions: The complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a 'membership' organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of 'membership' raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: This contribution is a response to the current issue of corporate governance in hospitals in the Czech Republic, which draw a significant portion of funds from public health insurance. This not only has a significant impact on the economic efficiency of hospitals, but ultimately affects the whole system of healthcare provision in the Czech Republic. Therefore, the effectiveness of the corporate governance of hospitals might affect the fiscal stability of the health system and, indirectly, health policy for the whole country., Objectives: The main objective of this paper is to evaluate the success of the transformation in connection with the performance of corporate governance in hospitals in the Czech Republic. Specifically, there was an examination of the management differences in various types of hospitals, which differed in their ownership structure and legal form., Methodology/approach: A sample of 100 hospitals was investigated in 2009, i.e., immediately after the transformation had been completed, and then three years later in 2012. With regard to the different public support of individual hospitals, the operating subsidies were removed from the economic results of the corporations in the sample. The adjusted economic results were first of all examined in relationship to the type of hospital (according to owner and legal form), and then in relation to its size, the size of the supervisory board and the education level of the senior hospital manager. A multiple median regression was used for the evaluation., Findings: One of the basic findings was the fact that the hospital's legal form had no influence on economic results. Successful management in the form of adjusted economic results is only associated with the private type of facility ownership. From the perspective of our concept of corporate governance other factors were under observation: the size of the hospital, the size of the supervisory board and the medical qualifications of the senior manager had no statistically verifiable influence on the efficiency of the hospital management, though we did record certain developments as a result of the transformation process. The economic results that were reported were significantly distorted by the operating subsidies from the founder., Practical Implications: The results can be used immediately on several practical levels: on the macro level as part of the state's formulation of health policy, particularly in the optimization of the structure of healthcare providers, as well as for the completion of reforms in legal forms and hospital founders, and on the micro level as part of the effective administration and governance of hospitals through corporate governance regardless of the form of ownership., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Federally qualified health centers (FQHCs), which must be governed by a patient majority, have historically struggled to remain financially viable while caring for a disproportionately low-income and uninsured population. Consumer governance is credited with making FQHCs responsive to community needs, but to the extent that patient trustees resemble the typical low-income FQHC patient, patient trustees might lack the capacity to govern, harming financial performance as a result. Thus, this study sought to empirically evaluate the relationship between FQHC board composition and financial performance., Methods: Using data from years 2002-2007 of the Uniform Data System and the Area Resource File, and years 2003-2006 of FQHC grant applications, FQHC operating margin was modeled as a function of board and executive committee composition, the interaction between them, general time trends, other FQHC and county-level factors, and FQHC-level fixed effects. Trustees were classified as representative (ie, low-income) consumers, nonrepresentative (ie, high-income) consumers, and nonconsumers on the basis of their self-reported patient status and occupation., Results: Each 10 percentage point increase in the proportion of representative consumers on the board is associated with a 1.7 percentage point decrease in operating margin. This effect becomes insignificant if any consumers serve on the executive committee. There is no significant relationship between the proportion of nonrepresentative consumers and operating margin., Conclusions: If consumers are given leadership roles on the board, consumer governance does not harm financial performance and may be beneficial enough in other respects to justify its being required as a condition of federal FQHC funding. Without such strengthening of the provision, consumer governance appears to harm financial performance and it is unclear from this study whether it offers other benefits that are significant enough to justify this financial risk.

Objective: To determine if the proportion of consumers on federally qualified health center (FQHC) governing boards is associated with their use of federal grant funds to provide uncompensated care., Methods: Using FQHC data from the Uniform Data System, county-level data from the Area Resource File and governing board data from FQHC grant applications, the uncompensated care an FQHC provides relative to the amount of its federal funding is modeled as a function of board and executive committee composition using fixed-effects regression with FQHC and county-level controls., Results: Consumer governance does not predict how much uncompensated care an FQHC provides relative to the size of its federal grant. Rather, the proportion of an FQHC's patient-mix that is uninsured drives uncompensated care provision., Conclusions: Aside from a small executive committee effect, consumer governance does not influence FQHCs' provision of uncompensated care. More work is needed to understand the role of consumer governance.

Using a unique data set, this study explores how type of ownership (government/private) is related to processes of governance. The findings suggest that the neo-institutional perspective and the self-interest rationale of the agency perspective are helpful in explaining processes of governance in both government- and privately owned non-profit organizations. Due to adverse incentives and the quest for legitimacy, supervising governance bodies within local government-owned non-profit institutions pay relatively less attention to the development of high quality supervising bodies and delegate little to management. Our findings also indicate that governance processes in private institutions are more aligned with the business model and that this alignment is likely driven by a concern to improve decision making. By contrast, our data also suggest that in local government-owned institutions re-election concerns of politicians-trustees are an important force in the governance processes of these institutions. In view of these adverse incentives - in contrast to the case of private organizations - a governance code is unlikely to entail much improvement in government-owned organizations., (Copyright © 2010 John Wiley & Sons, Ltd.)

With an expanded and overhauled Form 990, hospitals will find themselves digging up and reporting lots more details about executive pay and perks, governance policies, and how much subsidized care they provide. "We look at this as the first step," says the IRS' Theresa Pattara, left, who was project manager for the form's retooling.

Opinions about whether or not trustees should be paid waver between the belief that the need for sharpened board expertise demands compensation to the philosophy that payment is an affront to trustees' altruism.

This paper examines the way in which the Jewish question was handled by the Ordre des Médecins, a representative institution for the medical profession created by the Vichy government. It discusses the historiography of Vichy anti-Semitism generally and goes on to analyze the background of anti-Semitism in the French medical profession in the 1930s, comparing it with anti-Semitism in other professions such as Law. The paper then discusses the reactions of the Ordre des Médecins and its governing body, the Conseil Supérieur, to the Vichy anti-Semitic legislation which affected the profession and compares its brand of anti-Semitism with the official Vichy policy. It focuses on the unequal battle between the Conseil Supérieur, whose members were typically traditional nationalistic and protectionist anti-Semites, and the Vichy government, where quasi-racial anti-Semitism was official policy. It explains the inevitable defeat of the Conseil Supérieur.

Foundation Trust Hospitals are community-controlled health care providers which have increased autonomy about how they produce outcomes for the British National Health Service. Although there is a literature on hospital economics it is unclear how these innovative providers will behave, if they have to compete for scarce resources with other hospitals. This paper reviews some of the earlier theories, such as the neoclassical theory of the firm, and discusses their relevance along with 'newer' economic theories such as the transaction costs and evolutionary theory of the firm, plus organizational and human resources theory, to the performance of Foundation Trusts. Much contemporary health care provision is shaped along modernist lines, using scientific endeavour to maximize the impact on health outcomes and technical and social efficiency. However, there is an increasingly postmodern standpoint--critical of modernity--being taken by both patients and hospital staff, to deconstruct processes in the organizations that serve them. Foundation Trusts are postmodern hospitals insomuch as they (to attract scarce resources in a competitive environment), need to marshal the diverse theories of the firm together in order to provide a mass-customized, quality experience, transparently and at least cost--whilst maintaining a stable organizational culture for staff.

The Sarbanes-Oxley Act is intended to improve corporations' financial accountability, but boards of not-for-profit hospitals are taking their own cues from its provisions.

If a dam springs several leaks, there are various ways to respond. One could assiduously plug the holes, for instance. Or one could correct the underlying weaknesses, a more sensible approach. When it comes to corporate governance, for too long we have relied on the first approach. But the causes of many governance problems lie well below the surface--specifically, in critical relationships that are not structured to support the players involved. In other words, the very foundation of the system is flawed. And unless we correct the structural problems, surface changes are unlikely to have a lasting impact. When shareholders, management, and the board of directors work together as a system, they provide a powerful set of checks and balances. But the relationship between shareholders and directors is fraught with weaknesses, undermining the entire system's equilibrium. As the authors explain, the exchange of information between these two players is poor. Directors, though elected by shareholders to serve as their agents, aren't individually accountable to the investors. And shareholders--for a variety of reasons--have failed to exert much influence over boards. In the end, directors are left with the Herculean task of faithfully representing shareholders whose preferences are unclear, and shareholders have little say about who represents them and few mechanisms through which to create change. The authors suggest several ways to improve the relationship between shareholders and directors: Increase board accountability by recording individual directors' votes on key corporate resolutions; separate the positions of chairman and CEO; reinvigorate shareholders; and give boards funding to pay for outside experts who can provide perspective on crucial issues.

If you want to be successful, you need to spend money on improvements. As soon as you anticipate the need for a capital investment, start planning and exploring your financial opportunities.