Management Department


Date of this Version



Published in Health Care Management Review 36:2 (April/June 2011), pp. 145–154; doi: 10.1097/HMR.0b013e3182099f6e Copyright © 2011 Lippincott Williams & Wilkins, Inc. Used by permission.


Background: Despite pressures to change the role of hospital boards, hospitals have made few changes in board composition or director selection criteria. Hospital boards have often continued to operate in their traditional roles as either “monitors” or “advisors.” More attention to the direct involvement of hospital boards in the strategic decision-making process of the organizations they serve, the timing and circumstances under which board involvement occurs, and the board composition that enhances their abilities to participate fully is needed.

Purposes: We investigated the relationship between broader expertise among hospital board members, board involvement in the stages of strategic decision making, and the hospital’s strategic focus.

Methodology/Approach: We surveyed top management team members of 72 nonacademic hospitals to explore the participation of critical stakeholder groups such as the board of directors in the strategic decision-making process. We used hierarchical regression analysis to explore our hypotheses that there is a relationship between both the nature and involvement of the board and the hospital’s strategic orientation.

Findings: Hospitals with broader expertise on their boards reported an external focus. For some of their externally- oriented goals, hospitals also reported that their boards were involved earlier in the stages of decision making.

Practice Implications: In light of the complex and dynamic environment of hospitals today, those charged with developing hospital boards should match the variety in the external issues that the hospital faces with more variety in board makeup. By developing a board with greater breadth of expertise, the hospital responds to its complex environment by absorbing that complexity, enabling a greater potential for sensemaking and learning. Rather than acting only as monitors and advisors, boards impact their hospitals’ strategic focus through their participation in the strategic decision-making process.