Prevalence and compensation of academic leaders, professors, and trustees on publicly traded US healthcare company boards of directors: cross sectional study.

OBJECTIVE: To identify the prevalence, characteristics, and compensation of members of the boards of directors of healthcare industry companies who hold academic appointments as leaders, professors, or trustees. DESIGN: Cross sectional study. SETTING: US healthcare companies publicly traded on the NASDAQ or New York Stock Exchange in 2013. PARTICIPANTS: 3434 directors of pharmaceutical, biotechnology, medical equipment and supply, and healthcare provider companies. MAIN OUTCOME MEASURES: Prevalence, annual compensation, and beneficial stock ownership of directors with affiliations as leaders, professors, or trustees of academic medical and research institutions. RESULTS: 446 healthcare companies met the study search criteria, of which 442 (99%) had publicly accessible disclosures on boards of directors. 180 companies (41%) had one or more academically affiliated directors. Directors were affiliated with 85 geographically diverse non-profit academic institutions, including 19 of the top 20 National Institute of Health funded medical schools and all of the 17 US News honor roll hospitals. Overall, these 279 academically affiliated directors included 73 leaders, 121 professors, and 85 trustees. Leaders included 17 chief executive officers and 11 vice presidents or executive officers of health systems and hospitals; 15 university presidents, provosts, and chancellors; and eight medical school deans or presidents. The total annual compensation to academically affiliated directors for their services to companies was $54,995,786 (£35,836,000; €49,185,900) (median individual compensation $193,000) and directors beneficially owned 59,831,477 shares of company stock (median 50,699 shares). CONCLUSIONS: A substantial number and diversity of academic leaders, professors, and trustees hold directorships at US healthcare companies, with compensation often approaching or surpassing common academic clinical salaries. Dual obligations to for profit company shareholders and non-profit clinical and educational institutions pose considerable personal, financial, and institutional conflicts of interest beyond that of simple consulting relationships. These conflicts have not been fully addressed by professional societies or academic institutions and deserve additional review, regulation, and, in some cases, prohibition when conflicts cannot be reconciled.

Do patients have a voice? The social stratification of health center governing boards.

CONTEXT: To ensure community responsiveness, federally qualified health centres (FQHCs) in the United States are required to be governed by a patient majority. However, to the extent that these patient trustees resemble the typical low-income patients served by FQHCs, status generalization theory suggests that they will be passed over for leadership positions within the board in favour of more prestigious individuals. METHODS: Using 4 years of data on health centre governing boards obtained from the Health Resources and Services Administration via a Freedom of Information Act Request, the likelihood of holding executive committee office is modelled as a function of trustee characteristics using Chamberlain's conditional logistic regressions. RESULTS: The results indicate that representative patient trustees are significantly less likely than other trustees to hold a position on the executive committee or serve as board chair. CONCLUSIONS: Given the power of the board leadership to set the agenda, the reduced likelihood of representative patient trustees serving in leadership positions may ultimately limit the representative voice given to patients, making FQHCs potentially less responsive to their communities. These findings also have important implications for other settings where engaging and empowering patients is sought.

[Trusted person and living will: information and implementation defect]. / Personne de confiance et directives anticipées: défaut d'information et de mise en œuvre.

PURPOSE: The French law allows the persons of age to appoint a trusted person and to draft advance directives in case they are one day in a condition that prevents them from expressing their will regarding their health care. Our study objective was to assess patients' and relatives' knowledge and collecting their opinion regarding these means of expression of their will. METHODS: An anonymous survey by self-administered questionnaire was conducted in the admission offices of the University Hospital of Nancy in April 2011. The questions focused on trusted person and anticipated directives. RESULTS: We collected 367 answers, 61.8% of which were females. Average age of respondents was 48.7 years old (standard deviation: 15.6). Three fourths of respondents were informed of their possibility to appoint a trusted person and were able to establish the difference between a trusted person and a contact person. Respondents mainly chose their spouse (52%). They thought that the trusted person's opinion takes precedence over the family's or relatives' one (64.7%), given that this opinion is based on indications previously provided by the patient (74.8%). The majority of people surveyed were ignorant of the possibility to draft advance directives but were glad of it (57.5%). They would include herein their refusal of unreasonable obstinacy (75.8%), their wishes to withhold/withdraw of some treatments, to stop active treatments in case of high odds of chronic coma or vegetative state (52.8%) or their will to donate organ after death (50.6%). More than three fourths of the patients wished to include these informations on their health care card chip. CONCLUSION: Legal means of expression of the patient's wishes and are not systematically known by the population. The possibility to appoint a trusted person is much more known than that to draft advance directives. After the release in December 2012 of the Sicard report regarding the end of life in France, an important information campaign of the general public remains to be undertaken.

Impact of discussion on preferences elicited in a group setting.

BACKGROUND: The completeness of preferences is assumed as one of the axioms of expected utility theory but has been subject to little empirical study. METHODS: Fifteen non-health professionals was recruited and familiarised with the standard gamble technique. The group then met five times over six months and preferences were elicited independently on 41 scenarios. After individual valuation, the group discussed the scenarios, following which preferences could be changed. Changes made were described and summary measures (mean and median) before and after discussion compared using paired t test and Wilcoxon Signed Rank Test. Semi-structured telephone interviews were carried out to explore attitudes to discussing preferences. These were transcribed, read by two investigators and emergent themes described. RESULTS: Sixteen changes (3.6%) were made to preferences by seven (47%) of the fifteen members. The difference between individual preference values before and after discussion ranged from -0.025 to 0.45. The average effect on the group mean was 0.0053. No differences before and after discussion were statistically significant. The group valued discussion highly and suggested it brought four main benefits: reassurance; improved procedural performance; increased group cohesion; satisfying curiosity. CONCLUSION: The hypothesis that preferences are incomplete cannot be rejected for a proportion of respondents. However, brief discussion did not result in substantial number of changes to preferences and these did not have significant impact on summary values for the group, suggesting that incompleteness, if present, may not have an important effect on cost-utility analyses.

Trustees in transition. Survey shows it's time for boards to get with the program--or get eaten by the competition.

National surveys of hospital and system trustees, conducted by the AHA and Ernst and Young LLP, show that boards are evolving dramatically. And those that aren't don't stand a chance in the leadership race for the 21st century.

Education needs of hospital governing boards.

Hospital governing board members serve voluntarily, however they are integral to their hospitals' operations. This article investigates if there is a discrepancy between board members' knowledge of healthcare issues and how important they perceive these issues to be in their hospitals' operations and direction. In addition, it offers preliminary steps on how to ensure that board members are kept well-informed and up-to-date on issues for strategy planning in the healthcare marketplace.

Profile of the 1990s woman clinic manager.

Peg L. Stone updates two previous papers with an unflinching look the female membership of Medical Group Management Association and whether or not their numbers are well represented in association governance and member organization leadership.

Board evaluation and effectiveness: models, components and perspectives.

Health facility boards are being challenged to increase their effectiveness in the face of the changing health care environment. To this end, accreditation standards require boards to develop methods of evaluating their governing function and performance. During a survey of governance issues, the authors interviewed a group of health service executives with respect to board evaluation at their facilities. The responses yielded insights relating to models and components of evaluation, board missions and policies, mentoring programs and trustee education and orientation.

Governance of hospitals in Canada: a survey of business leaders who serve as hospital trustees.

The Caldwell Partners Amrop International, in the course of conducting executive search, are often in contact with business executives across Canada, many of whom serve as hospital trustees. Because of the concerns being expressed informally by these trustees, it was decided to conduct a formal survey. The University of Toronto's Department of Health Administration was involved in designing the survey instrument and tabulating the results. The survey's findings cover many governance issues, such as board size, composition, terms, representation, roles, mergers, evaluation, quality of care, research institutes, fiscal issues and government relations.

Are trustees prepared to lead through health reform maze?

Not all hospital trustees realize the vital leadership role they must play as their hospitals move toward the future, say CEOs. As a result, executives understand that they have a major educative role to play in bringing their boards up to speed on health care reform issues--quickly.