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As health care delivery organizations develop into integrated health care systems, new and significant challenges arise with respect to how such systems should be governed. This article explores several key governance issues that organizations are likely to encounter as they attempt to effect the transition from hospital or multihospital system governance arrangements to those appropriate for integrated systems.

Effectiveness is generally defined as "doing the right things." To be effective, boards of health systems and hospitals must have a clear, precise, and shared image of the type of work they should be doing to really govern their organizations. This article forwards a paradigm of board work--the five ultimate responsibilities and three core roles of governance. The paradigm is then employed to discuss the division of responsibilities and roles among boards and their standing committees, and superordinate and subordinate boards in tiered governance situations typical of many multifacility and integrated health care delivery systems.

A new organizational species is emerging--the integrated health care delivery system. Aligned with both the anticipated provisions of federal and state health care reform initiatives and emerging purchaser demands, integrated delivery systems could dominate many health care markets by the end of this decade. Integration is both the defining feature and key imperative of such systems. Because of the unique position of boards, governance is potentially the ultimate integrator. Yet little attention had been focused on integrated delivery system governance. Accordingly, this article will address the governance of integrated delivery systems through three questions: (1) What are the distinguishing characteristics of integrated health care delivery systems? (2) What are the distinctive issues and challenges associated with governing integrated delivery systems? and (3) What different forms of governance can be employed by these systems and what factors influence the effectiveness of these forms?

This paper describes the Public Health Leadership Institute (PHLI), a program designed to expand and enhance the leadership skills of senior public health officials. The background of PHLI is discussed, and organizations responsible for its organization, governance and funding are revealed. Methods of selecting a cohort of scholars to participate each year, along with the characteristics of scholars selected, are briefly outlined. A calendar of events and description of PHLI curriculum is included. Specific features of the PHLI program, including peer-learning through electronic conferencing, the one-week learning retreat, and the required action-learning projects are described. Also included are results from an evaluation by 99 participants from the first two years of PHLI's existence. The evaluation is based on a survey of the participants' satisfaction with the program and its personal and institutional effects. The Public Health Leadership Institute provides a model of leadership development for senior public health agency officials. The program has been popular with participants, and the vast majority report improved leadership skills. The personal and organizational effects of PHLI address the deficits in leadership identified in the Institute of Medicine's report, The Future of Public Health.

One of six different strategies must be selected for a health service offering to provide consumers with distinctive value and achieve sustainable competitive advantage in a market or market segment. Decisions must be made regarding objectives sought, market segmentation, market scope, and the customer-value proposition that will be pursued.

The health services industry is undergoing a revolution. Changing reimbursement and competitive dynamics are creating new incentives and constraints that demand different organizational responses. To survive, let alone thrive, health service organizations must enhance their level of creativity and innovation. This article describes the process of creativity and innovation, discusses barriers that impede the development of new services and products, and explores strategies for enhancing the creative and innovative potential of these organizations. Health service organizations that effectively and efficiently manage the generation and development of new ideas will have a significant competitive edge in the years to come. Organizational creativity and innovation will become the new "high ground" in the health services industry.

To survive, let alone thrive, in an increasingly competitive and threatening environment, health care organizations must skillfully manage their dependencies. Such dependencies traditionally have been managed through marketplace exchanges (buying and selling) and ownership relationships (acquisition, merger, and business development). An alternative strategy for designing and managing interorganizational relationships, the quasi-firm, is introduced. The quasi-firm is a hybrid market/ownership arrangement that allows participating organizations to pursue strategically important purposes while simultaneously preserving a high degree of functional and legal autonomy. We suggest that this distinctive interorganizational form is particularly well suited to the features of the new health care marketplace.

This article integrates and applies work in the general business literature to the design and execution of pricing decisions in hospitals. First, the emergence of pricing as an important function in hospitals is discussed. Second, four distinctly different strategies that can be employed by hospitals to price their offerings are described. Third, a variety of different pricing tactics, and their situational assets and liabilities, are reviewed. The article concludes with a series of recommendations for designing pricing strategies and tactics in the new health care marketplace.

In response to significant political, governmental, and socioeconomic changes affecting the health care industry, health care organizations are forming a wide variety of loosely coupled interorganizational arrangements. In this article, loosely coupled forms are classified according to the extent to which they are designed to achieve strategic purposes. The quasi firm is defined as a loosely coupled arrangement created to achieve long-lasting and important strategic purposes. Mechanisms that are needed to ensure the continuity of quasi firms are explored, and an agenda for further research is given.