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UBC Theses and Dissertations

The role of the voluntary hospital trustee : a case analysis Mitchell, Kirk Addison


The purpose of this study is to provide a critical examination of the concept of hospital governance in a community hospital in British Columbia. The format of the thesis is to model the development of the Canadian health system in an extensive case analysis. The case analysis approach permits the expounding of theoretical concepts of hospital trustee roles and functions. Through the application of qualitative research, the fundamental issue addressed was the involvement of the Lions Gate Hospital trustees with policy issues during a ten year period of analysis from January 1969 through December 1978. The hypothesis was that the hospital trustees were not substantially involved in policy making but were primarily concerned with operational management issues and this suggested that the role of the trustee did not evolve in concert with the change in the Canadian health system under national health insurance. The hypothesis was tested through application of the research methods of content analysis and grounded theory in a review of the minutes of the Board of Management and the annual reports. In tracing the evolution of the Canadian health insurance program, it was shown that the enactment of the hospital insurance components which preceded medical care insurance produced an emphasis on hospital care and diagnostic services rather than ambulant care. Cost sharing provisions initially for capital funding and later for operational costs encouraged and stimulated the demand for hospital facilities across Canada. With the advent of these third party Insurance schemes, the role of the hospital trustee should have changed from one of fundraiser to one of policy maker; however, the trustees at Lions Gate Hospital were found to be predominantly concerned with operational management issues rather than policy issues. National health insurance established the legitimacy of hospital trustees as policy makers and the professionalization of hospital administration established the feasibility of the Chief Executive Officers being held accountable for operational management. The missing link is support from the provincial government of British Columbia and the lack of definitive legislation and requirements embodied in the Hospital Act (RS Chapter 176; 1979). The current legislation inhibits policy making and long range planning and reinforces the conception of a hospital board as an administrative body. The lack of policy development initiatives by the Lions Gate Hospital trustees resulted from the restrictive mandate of the Hospital Act, the inadequate funding system for hospitals, the process of trustee selection, the education process for hospital trustees, the role of the Chief Executive Officer and the interaction with the organized medical staff. Weak and ineffective boundary spanning roles allowed the hospital trustees to function as an administrative board rather than a policy making board. The outcome of the analysis of the governance process at Lions Gate Hospital was an unfulfilled expectation that the hospital trustees would perform three basic functions - mandate, maintain and monitor.

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