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Hospital Governance Self Assessment Tool

*First Name:

*Last Name:

*Email:

*Title:

*Hospital:

*Address:

Address Extra:

*City:

*State:

Zip:

*Phone:

Fax:

STRATEGIC PLANNING

Has your Board received and adopted a meaningful strategic plan?

Yes
No

Does the hospital’s strategic plan include measurable goals that link to the community’s needs?

Yes
No

How often does the board regularly review progress towards meeting the goals outlined in the hospital’s strategic plan?

Monthly
Quarterly
Annually

Does the Board engage in meaningful discussion of the future and strategic issues at each board meeting?

Yes
No

QUALITY

Does the Board fulfill its responsibility in ensuring the quality of care in your organization?

Yes
No
Unsure

Does the Board review comparative and meaningful benchmarks for specific quality targets?

Yes
No

Does the Board review comparative and meaningful benchmarks for patient satisfaction?

Yes
No

MEDICAL STAFF

Does the Board delegate the responsibility of patient care, clinical quality, patient safety, physician credentialing and peer review to the medical staff?

Yes
No

Does the Board approved medical staff development plan assure that its medical staff members are available to meet the current and future medical needs of the community?

Yes
No

FINANCIAL

Are financial reports with key indicators presented in a format the Board can readily understand?

Yes
No

Does the Board approve specific financial targets and limits for key financial indicators [such as debt, liquidity, ROI, profitability] to provide an early indicator of financial difficulties?

Yes
No

Does the hospital have a Board approved 3-5 year financial plan which ties to the hospital’s strategic plan?

Yes
No

Does the Board require that all trustees have an adequate background in hospital financial reports and key indicators or receive adequate education to gain these skills?

Yes
No

MANAGEMENT

Does the Board delegate the responsibility for all hospital business affairs and daily operations to the CEO?

Yes
No

Is communication between the Board and the CEO effective?

Yes
No

Does a climate of mutual respect and trust exist between the Board and CEO?

Yes
No

Does the Board evaluate its own performance and the performance of individual members on an annual basis on an annual basis?

Yes
No

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Hospital Governance Self Assessment Tool

STRATEGIC PLANNING

QUALITY

MEDICAL STAFF

FINANCIAL

MANAGEMENT

Smart Tools

Quorum Health Resources