The founding of the Tata Memorial Hospital, 1932-1941.

This article presents a brief account of the founding of the Tata Memorial Hospital. It draws upon archival material to show that this was not a mere philanthropic act but a scheme carefully thought-out by the Trustees of the Sir Dorabji Tata Trust. It discusses the major concerns of the Trustees as they deliberated upon establishing the Hospital.

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.

Mission, margin, and the role of consumer governance in decision-making at community health centers.

OBJECTIVE: We explore the role of consumer trustees in decision-making as community health centers (CHCs) work to navigate the tension between pursuing their mission to provide primary care to all regardless of ability to pay and maintaining their limited finances. METHODS: We interviewed 30 trustees from 16 CHCs in 14 different states, asking extensively about decision-making processes at their CHC related to services and finances, as well as perceived advantages and disadvantages of consumer governance. RESULTS: Respondents described mission-dominant, margin-dominant, and balanced decision-making philosophies, and different decision-making pathways for service provision and finances. Consumer trustees were lauded for their role in informing the board of service quality and community needs, but criticized for being professionally unskilled and exhibiting a lack of objective decision-making. CONCLUSIONS: While CHC boards do play a role in navigating the tension between mission and margin, executive directors and staff appear to be more influential.

Legitimacy, trustee incentives, and board processes: the case of public and private non-profit nursing homes.

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.

Hospital board infrastructure and functions: the role of governance in financial performance.

Increased stake of boards in the leadership of the hospitals makes them play a significant role in the financial health of their institutions. Understanding of the correct approach to successfully fulfill this purpose is critical for preparing their organizations for positioning adequately in the health care market. Governmental agencies and public companies, including insurers, will be interested in the extent to which hospital boards have adopted the provisions of accounting reform laws like those introduced by the Sarbanes-Oxley Act. It will remain for the boards to balance their oversight role for financial performance with the pressures of financial accountability.