Helping boards transform their work to better guide health care organizations through the significant changes confronting them has been a primary focus for American Hospital Association’s Center for Healthcare Governance, Earlier this year, the Center added “Governance of Physician Organizations: An Essential Step to Care integration” to its governance transformation resources. This report shares findings from the Center’s landmark Blue Ribbon Panel study of how physician organizations are led and governed, and offers perspectives these organizations can consider in reviewing their own governance practices.

Executives and board members from several physician organizations participated in the study: Advocate Physician Partners, Downers Grove, Ill.; Billings (Mont.) Clinic; East Bay Physicians Medical Group, Lafayette, Calif.; Hill Physicians Medical Group, San Ramon, Calif.; Hospital Sisters Medical Group, Springfield, Ill.; and Memorial Hermann Physician Network, Houston.

The study was among the first to explore governance of physician organizations from the perspective of physicians who lead and govern them. Participants talk candidly about issues and challenges, and share insights about how these organizations are evolving. Key findings include:

• Broader governance competencies and outsider perspectives are needed to guide emerging care systems.

• Lively discussion, debate and willingness to challenge and offer dissenting views are governance strengths of study organizations.

• There is value in matching governance practices to organizational needs at various stages of development and in avoiding application of traditional biases from governance in other organizations.

• Orientation and continuous learning are critical for these boards.

• Board evaluation processes are still evolving.

The report includes a brief assessment exercise that boards and leaders can use to better understand progress along several dimensions of organizational development. It also calls for additional tools and resources to assist physician organization boards to improve their governance and address practice gaps such as the need to:

• understand the difference between governance and management, because physicians are involved at both levels in their organizations

• define relative roles, responsibilities and authorities among boards and management

• more rigorously use skill and behavioral competencies in board member selection, reappointment and succession

• develop deeper infrastructure (e.g., committees, outsider board members) to power good governance in younger and more mature organizations

• engage in more self-reflection on board capabilities to drive improved governance.

The Center has developed new surveys for boards of both freestanding physician organizations and those that are part of health systems to evaluate their governance performance and identify and address practice gaps. These surveys enable evaluation of board structure, practices and responsibilities. The surveys are being piloted with several physician-organization boards to validate and refine them. Feedback will be incorporated and surveys will be available for broader use later this year.

For information about these and other resources for physician organization governance, contact the AHA’s Center for Healthcare Governance at

John R. Combes, M.D. (, is chief medical officer and senior vice president, American Hospital Association, and president of the AHA’s Center for Healthcare Governance, Chicago.