The Governance Institute Blue Ribbon Committee Reframes Hospital and Health System Board Assessment with Four Considerations for Stronger Governance
The Governance Advantage identifies four considerations for strengthening strategic judgment, advancing continuous
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The Governance Institute (TGI), a service of NRC Health, today released The Governance Advantage: Four Considerations for Hospital and Health System Board Assessment, a new report from its Blue Ribbon Committee on Hospital and Health System Board Assessment that identifies four considerations for boards to incorporate into their next assessment and current development efforts.
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“The Governance Advantage offers a compelling, practical set of considerations that respects both the responsibilities of boards and the unique circumstances of the organizations they govern. Most importantly, it is focused not simply on assessing the board of today, but on building the governance capabilities organizations will need for the more volatile operating conditions ahead,” said David Burik, Executive Vice President, Strategic Insights, NRC Health
The Committee points to affordability and reimbursement pressures, demographic change, workforce constraints, and rapidly advancing technology as forces placing a premium on board effectiveness. The report recommends that traditional reviews of board performance remain important but be complemented by a focus on the governance capabilities an organization needs today and for what comes next.
Four considerations for stronger governance
Rather than prescribing a single governance model, the Blue Ribbon Committee identifies four considerations for hospital and health system boards to incorporate into their next assessment and ongoing board-development efforts:
1. Effective governance is a strategic advantage worth investment.
Strong boards can help organizations make better strategic decisions. Independent judgment, informed challenge, diverse perspectives, and an understanding of mission and community needs help boards test assumptions, consider alternatives, and strengthen major choices before management executes them.
2. Effective governance requires ongoing self-improvement.
Assessment should lead to improvement, not simply a completed evaluation. Boards should use findings to strengthen leadership, committees, succession, individual director/trustee contribution, the CEO partnership, and follow-through. The measure of a successful assessment is not that it was completed, but that governance improves as a result.
3. Effective governance is fueled by board member fluency.
Trustees do not need to be experts in every issue, but they need enough understanding to ask informed questions, evaluate strategic alternatives, and exercise sound judgment. Expertise can be hired. Governance judgment must be developed. Education, experience, and exposure—the Three Es—build the fluency trustees need to govern increasingly complex and interconnected issues.
4. Effective governance must keep pace with the Great Governance Migration.
As hospitals join larger regional and multistate systems, governance increasingly extends across multiple boards and levels of the organization. Assessment should examine whether each board has a useful role, is prepared to perform it, and connects community insight with enterprise decisions. The report calls this broader movement the “Great Governance Migration”—not simply the consolidation of hospitals, but the movement and redistribution of governance itself.
“The experience and insights brought together through this Blue Ribbon Committee have not resulted in another one-size-fits-all prescription for good governance,” said David Burik, Executive Vice President, Strategic Insights, NRC Health. “Instead, The Governance Advantage offers a compelling, practical set of considerations that respects both the responsibilities of boards and the unique circumstances of the organizations they govern. Most importantly, it is focused not simply on assessing the board of today, but on building the governance capabilities organizations will need for the more volatile operating conditions ahead.”
The Committee emphasizes that there is no single governance destination. An organization’s mission, history, ownership, legal context, geography, strategy, communities, and governance journey should shape what it needs from its board next. Its challenge to boards is straightforward: Assess the governance you will need—not only the board you have. The objective is not more governance, but better governance—a board that knows where to engage, where to challenge, and where to give management room to lead.
The Governance Advantage builds on The Governance Institute’s April 2026 report, Falling Behind: Health System Operations Are Advancing Faster Than Governance, which asked whether healthcare governance has kept pace with the growth, complexity, and changing operations of hospitals and health systems.
“When The Governance Institute published Falling Behind, asking whether healthcare governance has kept pace with hospital and health system growth and operations, it also asked a panel of healthcare CEOs, directors, academics, and legal and capital-markets experts to come together to give the subject of governance further consideration,” said James S. Hunt, CPA, Chair of the Blue Ribbon Committee and Chair of the Board of Directors of Nemours Children’s Health. “The Committee’s work provided important input and helped develop the conclusions reached in today’s publication, The Governance Advantage. The paper offers perspectives for boards of directors and trustees to consider as they develop their governance plans in support of their respective CEOs and the organizations they oversee.”
The Governance Advantage: Four Considerations for Hospital and Health System Board Assessment was prepared by David Burik and Andrew Donahue and commissioned by The Governance Institute.
The Governance Institute works with hospital and health system boards to assess governance effectiveness, identify opportunities for improvement, and strengthen the capabilities boards need for the decisions ahead.
Download the Governance Advantage report: https://go.nrchealth.com/the-governance-advantage-report
About The Governance Institute
The Governance Institute, a service of NRC Health, provides trusted, independent information, resources, tools, and solutions to board members, healthcare executives, and clinician leaders in support of their efforts to lead and govern their organizations. The Governance Institute supports not-for-profit hospital and health system boards through research, publications, conferences, assessments, education, and advisory services.
About NRC Health
For 45 years, NRC Health (NASDAQ: NRC) has led the charge to humanize healthcare and support organizations in their understanding of each unique individual. NRC Health’s commitment to Human Understanding helps leading healthcare systems get to know the patients, families, consumers, employees, and communities they serve on a human level. Guided by its uniquely empathic heritage, human-centered approach, unmatched national market research, and emphasis on consumer preferences, NRC Health is transforming the healthcare experience, creating strong outcomes across the healthcare journey.
The organization recently received the 2026 Best in KLAS Award for Healthcare Experience Management, independently validating NRC Health’s relentless pursuit of excellence in healthcare through innovation and deep partnerships that bring together its comprehensive experience management platform, advanced technology, and proven techniques to drive the most human healthcare experiences.
For more information, email info@nrchealth.com or visit NRC Health.
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