Open Access Open Badges Research article

Implementation of hospital governing boards: views from the field

Zahirah McNatt1, Jennifer W Thompson1, Abraham Mengistu2, Dawit Tatek1, Erika Linnander1, Leulseged Ageze3, Ruth Lawson4, Negalign Berhanu5 and Elizabeth H Bradley1*

Author Affiliations

1 Yale University School of Public Health, 60 College Street, P.O. Box 208034, New Haven, Connecticut 06520-8034, USA

2 Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia

3 Abt Associates, Addis Ababa, Ethiopia

4 Department for International Development, Abuja, Nigeria

5 Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia

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BMC Health Services Research 2014, 14:178  doi:10.1186/1472-6963-14-178

Published: 17 April 2014



Decentralization through the establishment of hospital governing boards has been touted as an effective way to improve the quality and efficiency of hospitals in low-income countries. Although several studies have examined the process of decentralization, few have quantitatively assessed the implementation of hospital governing boards and their impact on hospital performance. Therefore, we sought to describe the functioning of governing boards and to determine the association between governing board functioning and hospital performance.


We conducted a cross-sectional study with governing board chairpersons to assess board (1) structure, (2) roles and responsibilities and (3) training and orientation practices. Using bivariate analysis and multivariable regression, we examined the association between governing board functioning and hospital performance. Hospital performance indicators: 1) percent of hospital management standards met, measured with the Ethiopian Hospital Reform Implementation Guidelines and 2) patient experience, measured with the Inpatient and Outpatient Assessment of Healthcare surveys.


A total of 92 boards responded to the survey (96% response rate). The average percentage of EHRIG standards met was 58.1% (standard deviation (SD) 21.7 percentage points), and the mean overall patient experience score was 7.2 (SD 2.2). Hospitals with greater hospital management standards met had governing boards that paid members, reviewed performance in several domains quarterly or more frequently, developed new revenue sources, determined services to be outsourced, reviewed patient complaints, and had members with knowledge in business and financial management (all P-values < 0.05). Hospitals with more positive patient experience had governing boards that developed new revenue sources, determined services to be outsourced, and reviewed patient complaints (all P-values < 0.05).


These cross-sectional data suggest that strengthening governing boards to perform essential responsibilities may result in improved hospital performance.

Governance; Decentralization; Ethiopia; Healthcare reform