Table 5.

Quotes identifying concerns related to hospital governing board functioning (open-ended responses)

Theme #1. Unclear authority of the Governing Board (GB)
Ambiguity in authority between GB and hospital management
•	The GB doesn't have authority to make decision on incentives.
•	Decisions made by GB have not implemented.
•	Even though hospital employees have ethical problems, the GB cannot take action because its role has not been clearly stated.
•	The role of GB in hospital should be stated clearly.
•	It would be good if the role and responsibility of GB and hospital management had clear demarcation.
•	What has been decided by the GB has not fully implemented.
•	The role of GB in taking actions on hospital employees when problems arise within in the hospital is not clearly stated.
•	The GB do not have full authority for every activity that took place in the hospital and if problems arose in the hospital, [they] do not taken corrective actions.
Ambiguity in authority between the GB and regional health bureau (RHB)
•	The GB has been ordered direct procurement of drugs but the regional regulations did not allow that.
•	The GB has limited authority to take corrective actions on employees. This is in the authority of civil service and health office.
•	There is no autonomy; decisions made by the GB have been violated by the regional health bureau.
•	The GB cannot participate in drug control and auditing because the role of GB in this regard is unclear, and this has resulted in drug wastage.
•	Sometimes the regional economic and development bureau interfere in budgeting, which was the GB’s responsibility.
•	It would be better if the CEO could report directly to the GB instead of regional health bureau.
Theme #2. Inadequate commitment and limited incentives for members to meet as a GB
•	Even though it is good to have a GB, the GB members are busy with their actual work; they do not have enough time to work for the GB.
•	In our zone, one person chairs three hospitals, which is inconvenient for the chair because he does not have enough time to get to know all information about the hospitals.
•	Most of GB members were high government officials; hence they do not give enough time to the GB committee.
•	Most of the governing board members are high government officials [and] they don’t [dedicate] enough time to the governing board.
•	The GB has not been meeting regularly.
•	The GB has never met every month [as it was supposed to] based on the legislation.
•	We have a shortage of time to monitor the hospital for we were busy.
•	Community representatives have not attended meeting as needed because they have private businesses.
•	The GB chair and members have been changed frequently.
•	We have concerns that some GB members may not be able to attend board meetings.
•	Inadequate payment for GB members.
•	Small GB members’ payment.
•	Little incentive payment to GB members.
•	There have been problems that the GBs were not performing well due to lack of payment
Theme #3. Ineffective communication and collaboration between the GB and the RHB
•	The GB and RHB have to meet at least twice a year (inferring they do not).
•	It would be good if the GB authority was limited and had been controlled by the RHB.
•	[There is] no relationship between GB and the RHB; hospital data have exclusively been reported to the RHB (rather than to the GB and then to the RHB.
•	The GB reports to the RHB, so the RHB [should] work closely with the GB, follow challenges of the GB, solve financial problems, and human resource.
Theme #4. Unmet training needs for GB members
•	Training should be given to GB members before they start work as GB members.
•	Give adequate training to employees in order to help them provide the community with faster service.
•	If GB members have received training on project designing… effective management style…how to give incentive to hospital staffs and retain them.
•	If the GB could receive all of the above-mentioned trainings.
•	[The GB needs] more capacity building training.
•	We lack of knowledge on how to lead hospital services because the GB members are not trained.
•	There should be orientation program for new GB members.
•	Training giving time and place should be convenient to members.
•	There should be an orientation program for new governing board members” and all additional training should be provided “on site, [rather] than outside of the district (another respondent).
Theme #5. Inadequate representation from community, district and zonal levels on GB
•	If GB composition comprised more community representatives, [that would be better].
•	It would be better if the GB composition comprised more community representatives.
•	The GB members of district hospital are assigned by zone and reported to zone that implies the board [is not from the community] and does not have direct relationship with region and has less power.
•	It would be better if the GB members were nominated from the district [more local] administration than from zonal administration.
•	It would be better if the GB members for district hospital had been nominated from the district administration.
•	The current GB comprises members from the same district administration, so it would be better if the composition could from different districts [that the hospital serves].
•	According to the legislation GB chair for zonal/general hospital should have been from zonal administration, but due to distance from the zonal town and [because] the zonal administrators not were unable to come for the GB meetings, the current GB is chaired by district administrator.