The organizational environment

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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)

(2) Patron Model

According to Garber (1997), this model includes:

? Similar to the Advisory Board model, the board of directors in the Patron Model has even less influence over the organization than an advisory board.
? Composed of wealthy and influential individuals with a commitment to the mission of the organization, the Patron Board serves primarily as a figurehead for fund raising purposes.
? Such boards meet infrequently as their real work is done outside board meetings. Writing cheques and getting their friends to write cheques is their contribution to the organization.
? Many organizations maintain a Patron Board in addition to their governing boards. For capital campaigns and to establish credibility of newly formed organizations, Patron Boards can be especially helpful.
? They cannot be relied upon, however, for governance tasks such as vision development, organizational planning, or program monitoring. (Garber, 1997)

(3) Co-operative Model

According to Garber (1997), this model includes:

? For a number of different reasons, some organizations try to avoid hierarchical structures.
? The decision-making structure in such organizations is typically labeled "peer management" or "collective management".
? In this model, all responsibility is shared and there is no Chief Executive Officer.
? Decision-making is normally by consensus and no individual has power over another.
? If the law did not require it, they would not have a board of directors at all.
? In order to be incorporated, however, there must be a board of directors and officers. The organization therefore strives to fit the board of directors into its organizational philosophy by creating a single managing/governing body composed of official board members, staff members, volunteers, and sometimes clients.
? Seen by its advocates as the most democratic style of management, it is also, perhaps, the most difficult of all models to maintain, requiring among other things, a shared sense of purpose, an exceptional level of commitment by all group members, a willingness to accept personal responsibility for the work of others, and an ability to compromise.
? When working well, the organization benefits from the direct involvement of front-line workers in decision-making and the synergy and camaraderie created by the interaction of board and staff. (Garber, 1997)

According to Garber (1997), there are two concerns with this model including:

? The first is that although the ability to compromise is an essential element in the successful functioning of this model, cooperatives often arise out of a strong ideological or philosophical commitment that can be inimical to compromise.
? The second concern is the difficulty of implementing effective accountability structures. At the time of implementing this ...