| Course | DHA 711 Administration of Complex Health Care Systems (DHA/711) |
|---|---|
| Week | 6 |
| Paper type | Governance evaluation paper |
| Length | about 1,158 words, 4 double-spaced pages plus title page and references |
| Format | APA 7 student paper |
| School | University of Phoenix |
| Program | DHA |
| Updated | September 2026 |
Free sample paper for DHA 711 Week 6
One System Board, Eleven Hospital Boards and 143 Trustees: Evaluating Whether a Network's Governance Structure Fits Its Strategy
[Student Name]
University of Phoenix
DHA/711: Administration of Complex Health Care Systems
Week 6 Assignment
[Instructor Name]
[Date]
The network, its boards, trustees, meeting practices and reform options are composites written for a model paper; research findings come from the sources cited.
A rural hospital in the network needed a new emergency department. The project required approval from the hospital's board, a regional capital committee and the system board, with each asking for revisions. Nine months passed between the first proposal and final approval, while patients waited in a department built for half its current volume. The regional vice president asked whether the network's governance structure served its strategy. This paper evaluates that structure and recommends changes.
Mapping the Current Structure
At the top sits a system board of 17 members. Each of its eleven hospitals has a subsidiary board, averaging 11 members, for a total of 143 trustees. Hospital boards approve local budgets, medical staff credentials and quality plans; the system board reserves authority over capital above $2 million, strategy, bylaws and chief executive appointments. In practice, many decisions pass through both levels, with overlapping reviews.
Where Authority Is Unclear
Unclear authority shows up in delays and frustration. Hospital boards believe they approve quality plans, but system service lines set protocols. Capital thresholds push most rural projects to the system board. Hospital presidents report to both their boards and system executives, creating dual accountability that no one has defined.
Composition and Competencies
Hospital boards are largely philanthropic in style: local business owners, clergy, educators and donors, valued for community ties. The system board is more corporate, with finance, legal and health care executives. Few trustees at either level have clinical quality or information technology expertise, the areas where the network's biggest decisions now fall.
Evidence on Board Models
Board style matters. A study of not-for-profit community hospitals found that those governed by boards using a corporate governance model, rather than philanthropic-style boards, were likely to be more efficient and have more admissions and a larger share of the local market, with occupancy and cash flow unrelated to board configuration and effects more pronounced in freestanding and public hospitals than in system-affiliated ones (Alexander & Lee, 2006). The finding suggests that within a system, subsidiary board style may matter less than the system board's.
Evidence on Quality Oversight
Boards' attention to quality is often limited. Jha and Epstein's national survey of board chairs found quality trailing other concerns on many boards, with training in quality rare, and it found that boards at better-performing hospitals simply behaved differently, devoting more time and attention to it (Jha & Epstein, 2010). The network's hospital boards spend most meeting time on local finances and facilities, and the system board reviews quality only quarterly.
Evidence Linking Boards and Management
Board attention appears to travel down the organization. Tsai and colleagues found, across hospitals in the United States and England, that stronger management practices went with higher-quality care and that hospitals whose boards focused on and used clinical quality measures had managers who monitored performance and set targets more effectively (Tsai et al., 2015). Where boards pay attention to quality, managers do too.
What Trustees Said
Interviews with 24 trustees revealed frustration on both levels. Hospital trustees said they spent hours reviewing budgets they could not change and felt their communities' concerns reached the system board too late. System trustees said they received too little information to judge local proposals and too much detail on matters that should be delegated. Several rural trustees said they served mainly to protect their hospital from closure.
Criteria for Evaluating Options
The evaluation used five criteria set in advance: speed of decisions, strength of quality oversight, board competencies, community voice and legitimacy and cost and burden of governance.
Option One: A Single System Board With Local Advisory Councils
Dissolving hospital boards in favor of one system board with advisory councils would speed decisions and concentrate expertise. But it would reduce community voice, particularly in rural towns, and risk losing trustees who raise funds and defend the hospital locally. Community legitimacy would suffer.
Option Two: Regional Boards With Delegated Authority
Replacing eleven hospital boards with three regional boards, each with defined delegated authority, would reduce trustees to about 50, allow each board to recruit needed competencies and keep community representation. Delegating capital decisions up to $5 million would let most rural projects be decided regionally.
Option Three: Status Quo With Clearer Reserved Powers
Keeping the current structure but clarifying reserved powers and delegations would be least disruptive but would leave 143 trustees and duplicated reviews, addressing clarity but not burden or competencies.
Comparing the Options
Against the criteria, Option Two scored best overall: faster decisions than today, better competencies through regional recruitment, strong quality oversight if paired with practice changes and preserved community voice. Option One scored highest on speed but lowest on legitimacy. Option Three scored lowest on burden.
The Recommendation
The network should adopt regional boards with a written matrix of reserved powers and delegations, a minimum of two trustees with clinical quality expertise per board and quality as the first agenda item at every meeting. Each rural community would keep at least two seats on its regional board, and local advisory councils would continue fundraising and community engagement.
Practice Changes Alongside Structure
Structure alone will not improve oversight. Every board will receive a concise quality dashboard, trustees will complete quality training and the system board will review quality monthly. Board self-assessments will track time spent on quality and trustees' confidence in overseeing it.
Regional Boundaries
The three regions would group hospitals by referral patterns and geography: a coastal region anchored by a regional hospital, a central region around the academic center and a rural region combining the four small hospitals with a nearby regional hospital. Grouping rural hospitals together gives them a stronger collective voice than they have as separate subsidiaries of very different sizes.
Implementation
Implementation would take eighteen months: consultation with current trustees and communities, bylaw changes, transitional appointments and training. Some trustees will lose seats; the network will honor their service and invite them to advisory councils.
Risks of the Change
Governance changes carry risks. Trustees who lose seats may withdraw support, including donations. Communities may read consolidation of boards as a step toward closing hospitals. Regional boards could still be dominated by the largest hospital in each region. The network will address these risks with transparent communication, guaranteed rural seats, advisory councils for former trustees and a review of the structure after two years.
Measures of Success
Measures include time from proposal to decision for capital projects, percentage of board time on quality, trustee competency coverage, community satisfaction with representation and quality performance over time.
Conclusion
The network's governance structure, with 143 trustees and overlapping authority, slows decisions and weakens quality oversight. Evidence suggests corporate-style governance can improve performance, that boards often neglect quality and that board attention to quality strengthens management. Regional boards with clear delegations, needed competencies and preserved community seats, combined with changes in practice, offer the best fit for the network's strategy.
References
Alexander, J. A., & Lee, S. D. (2006). Does governance matter? Board configuration and performance in not-for-profit hospitals. The Milbank Quarterly, 84(4), 733-758. https://doi.org/10.1111/j.1468-0009.2006.00466.x
Jha, A., & Epstein, A. (2010). Hospital governance and the quality of care. Health Affairs, 29(1), 182-187. https://doi.org/10.1377/hlthaff.2009.0297
Tsai, T. C., Jha, A. K., Gawande, A. A., Huckman, R. S., Bloom, N., & Sadun, R. (2015). Hospital board and management practices are strongly related to hospital performance on clinical quality metrics. Health Affairs, 34(8), 1304-1311. https://doi.org/10.1377/hlthaff.2014.1282
What the DHA 711 Week 6 instructions ask
The sixth DHA 711 assignment typically asks students to evaluate governance structures in a complex health system. Expect to describe the current board structure and who holds which authority, compare governance models such as centralized, subsidiary and advisory boards and corporate and philanthropic styles, assess board composition, competencies and practices, apply evidence on governance and performance and recommend changes that fit the system's strategy while preserving community accountability. Some versions ask students to design a board structure. Include roles and reserved powers if so. Strong papers map who decides what, use evidence rather than preference, weigh efficiency against local legitimacy and propose specific changes to structure, composition and practice.
How this DHA 711 Week 6 example is built
A capital decision that took nine months because it needed approval from a hospital board, a regional committee and the system board opens the paper. The current structure is mapped: a system board, eleven subsidiary hospital boards and 143 trustees with overlapping authority. Evidence compares corporate and philanthropic board models. Evidence on board attention to quality and its link to management is reviewed. Three options are evaluated: a single system board with local advisory councils, regional boards with delegated authority and the status quo with clearer reserved powers. Criteria include speed, quality oversight, community voice and competencies. A recommendation with implementation steps, practice changes and measures closes the paper.
DHA 711 Week 6 grading rubric: where the points go
The governance evaluation week is typically graded on a clear analysis of current governance, evidence-based comparison of options and a practical recommendation. Graders look for the current structure and authority described, governance models compared, board composition and practices assessed, research on governance and performance applied, criteria for evaluating options, trade-offs between efficiency and local accountability and a recommendation with implementation steps. Governance research strengthens the paper, particularly studies connecting board structure and attention to performance. Defining reserved powers clearly earns credit, as does a matrix showing who decides what. Preserving community voice also earns marks. Doctoral writing and exact references round out the grade. Recommendations based on preference without evidence usually score lower, as do structures with no plan for the trustees who lose seats.
DHA 711 Week 6 help: mistakes to avoid
Many DHA 711 Week 6 papers describe boards without showing who actually decides. Map authority: which decisions each board makes, approves or merely hears about. Count how long major decisions take and where they stall, using real cases. Compare governance models using evidence on board style and performance and on boards' oversight of quality. Set criteria before comparing options, such as speed, quality oversight, competencies and community voice. Weigh what the system gains from centralization against what communities lose. Finally, recommend specific changes to structure, composition and practice, with steps and measures to judge whether governance improves, and plan how displaced trustees will stay involved.
Related DHA 711 sample papers
Other DHA 711 week samples
- DHA 711 Week 1: Complex Health Systems
- DHA 711 Week 2: Theory Applied to a System
- DHA 711 Week 3: System Structure Analysis
- DHA 711 Week 4: Strategic Planning Across Units
- DHA 711 Week 5: Multi-Organizational Management
- DHA 711 Week 7: Strategic Decision Critique
- DHA 711 Week 8: System Recommendations
More DHA sample papers
DHA 711 Week 6 questions, answered
What does DHA/711 Week 6 usually ask for?
The sixth complex systems paper typically asks students to evaluate governance structures, compare models, assess composition and practices and recommend changes that fit the system's strategy.
Where can I find a free DHA 711 Week 6 sample paper?
The governance evaluation above is free to read; notes explain each option. Describe your system's boards; your first paper is free.
What is the difference between corporate and philanthropic board models?
Corporate-style boards are smaller, include executives and emphasize strategy and performance oversight; philanthropic-style boards are larger, focus on fundraising and community ties and often include many local leaders.
Do board models affect hospital performance?
A study of not-for-profit community hospitals found those with corporate-style boards were more efficient, had more admissions and a larger market share than those with philanthropic-style boards, with stronger effects in freestanding hospitals.
What are reserved powers in a health system?
Decisions a parent system board keeps for itself, such as approving budgets, capital projects, bylaws and executive appointments, while delegating other decisions to subsidiary boards.
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