1. How do the governance models of health systems differ according to the context of the organizational environment? Please specify the environmental context and the governance model appropriate to it.

2. What are constraints or facilitating factors that hinder or help promulgate the vision, mission, and philosophy of your organization? How can you address the factors you identified?

3. What is the power of organizational culture? To what degree does this power or culture inhibit or facilitate the organizational leader’s ability to change the culture? Can the leader change the organizational culture? If so, how; and in what time frame?

 

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1. How do the governance models of health systems differ according to the context of the organizational environment? Please specify the environmental context and the governance model appropriate to it.

Based on unique needs and circumstances, local governments throughout the country employ a range of models to administer their hospital and public health systems (Alternative Governance Models,2009). However, there are no fixed criteria in terms of matching one context to model, but some models are found to be more practical in some health environments.

For example, nonprofit healthcare organizations have boards by law, and they tend to follow one of five different approaches to governance. Each approach emphasizes different dimensions of the roles and responsibilities of the board and each arises out of a different relationship between board members and staff members. The choice of model is influenced by the size, purpose, and history of the organization. The five governance models include: Advisory Board Model, the Patron Model, the Co-operative model, the Management Team Model, and the Policy Board Model. (Garber, 1997).

(1) Advisory Board Model

According to Garber (1997), this model includes:

? Emphasizes the helping and supportive role of the Board and frequently occurs where the CEO is the founder of the organization.
? The Board’s role is primarily that of helper/advisor to the CEO.
? Board members are recruited for three main reasons: they are trusted as advisors by the CEO; they have a professional skill that the organization needs but does not want to pay for; they are likely to be helpful in establishing the credibility of the organization for fundraising and public relations purposes.
? Individual board members may be quite active in performing these functions and consequently feel that they are making a valuable contribution to the organization. Board meetings tend to be informal and task-focussed, with the agenda developed by the CEO.

? The Advisory Board model can work well for a short time in many organizations but it exposes the board members to significant liability in that it fails to provide the accountability mechanisms that are required of boards of directors.
? By law, the board has the obligation to manage the affairs of the organization and can be held accountable for certain actions of employees and committees.
? It must therefore maintain a superior position to the CEO.
? Although the board is permitted to delegate many of its responsibilities to staff or committees, it cannot make itself subordinate to them. (Garber, 1997)

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