The Governance Institute Releases Falling Behind Report, Warning Health System Operations Are Advancing Faster than Governance

Released during TGI’s 250th Leadership Conference, the report calls for a redesign of governance to match the complexity of modern healthcare.

SCOTTSDALE, Ariz.--(BUSINESS WIRE)--The Governance Institute (TGI), a service of NRC Health, today released Falling Behind: Health System Operations Are Advancing Faster than Governance, a new governance brief examining whether today's health system governance models are keeping pace with the scale, complexity, and speed of modern healthcare.

The report was released during TGI's 250th Leadership Conference in Scottsdale, Arizona, where healthcare trustees, executives, physician leaders, and governance experts are gathering under the theme, "A defining moment for healthcare governance."

Falling Behind argues that U.S. healthcare has outgrown the way it is governed. A shrinking number of boards now oversee larger, more interconnected systems, while artificial intelligence, federal policy shifts, workforce strain, reimbursement pressure, market disruption, and rising expectations are increasing both the complexity of decisions and the stakes of getting them wrong.

"This is not a critique of boards. It is a recognition that healthcare has advanced faster than the governance model supporting it,” said Steve Kett, Chief Executive Officer of The Governance Institute. “Boards are deeply committed, but commitment alone is not enough. Governance must now be designed, developed, and supported as a core enterprise capability."

The report highlights several data points that underscore the scale of the challenge:

• An estimated 1,500 fiduciary boards oversee roughly $900 billion in hospital net patient revenue across the mission-driven hospital sector.
• Roughly 70 percent of boards lack continuing education requirements, while average board meeting time spent on director education is less than 10 percent.
• TGI estimates that less than 0.01 percent of hospital patient revenue is invested in board development.

The report further identifies two major consequences of the governance gap: degraded decision quality and weaker feedback across complex health systems. When boards lack the structures and information flow needed to integrate decisions, issues such as quality, workforce, finance, strategy, risk, digital transformation, access, and mission can be considered in silos rather than as interconnected enterprise decisions.

"NRC Health's work is grounded in the belief that better understanding drives better decisions,” said David Burik, Executive Vice President, Strategic Insights for NRC Health. “This report extends that idea into the boardroom. The next era of healthcare requires governance that can listen across the enterprise, integrate what it hears, and act with confidence."

Introducing the Governance Trilogy™

Falling Behind introduces TGI's Governance Trilogy™, a practical maturity framework designed to help boards identify the governance capability they have built and the capability they need next:

• Intentional Governance™ - Foundation: the board masters responsibilities, including role clarity, authority, structure, recruitment, education, evaluation, and accountability.
• Integrated Governance™ - Decision quality: the board weighs quality, workforce, finance, strategy, risk, digital, access, and mission together so tradeoffs are explicit.
• Enterprise Governance™ - System performance: the governance system is designed for scale, with clear decision rights, distributed authority, accountability, and feedback loops.

Next step: Blue-Ribbon Committee on Health System Governance

TGI also announced that it will convene a Blue-Ribbon Committee on Health System Governance this summer. The committee will bring together experienced trustees, health system leaders, clinicians, governance experts, legal and regulatory advisors, capital markets perspectives, and innovation leaders to inform the next phase of governance practice and revitalize TGI's board assessment approach.

Click here to read the full report.

About The Governance Institute

The Governance Institute, a service of NRC Health, provides trusted, independent information, resources, tools, and solutions to board members, healthcare executives, and clinician leaders in support of their efforts to lead and govern their organizations. TGI supports not-for-profit hospital and health system boards through research, publications, conferences, assessments, education, and advisory services.

About NRC Health

For 45 years, NRC Health (NASDAQ: NRC) has led the charge to humanize healthcare and support organizations in their understanding of each unique individual. NRC Health’s commitment to Human Understanding helps leading healthcare systems get to know the patients, families, consumers, employees, and communities they serve on a human level. Guided by its uniquely empathic heritage, human-centered approach, unmatched national market research, and emphasis on consumer preferences, NRC Health is transforming the healthcare experience, creating strong outcomes across the healthcare journey.

The organization recently received the 2026 Best in KLAS Award for Healthcare Experience Management, independently validating NRC Health’s relentless pursuit of excellence in healthcare through innovation and deep partnerships that bring together its comprehensive experience management platform, advanced technology, and proven techniques to drive the most human healthcare experiences.

For more information, email [e-mail] or visit www.nrchealth.com.