1) Knowing what governance is.

CEO is responsible to board for implementing its plans and strategic direction. Board is responsible for developing corporate policies and plans; monitoring and measuring organizational performance against those policies and plans; and acting as the voice of the ownership of the hospital. Board’s governance responsibilities are to provide a linkage between the hospital and its moral ownership; monitor the performance of the CEO; and develop an explicit statement of values for the hospital.

2) Achievement of Strategic ends.

To be effective by providing the right service, at the right place, at the right time and at an affordable cost.

3) Board-CEO Relationship.

Relationship is typified by a high level of mutual trust and confidence throughout the organization and particularly between the board of directors and CEO. Governance viewed as a solemn partnership between the board and CEO. Board members and the CEO are equals, colleagues. Organizations should be conceived of as a number of concentric circles with clients in the uttermost circle and the CEO in the inner circle.

4) Unity of Direction.

The CEO and Board should function as a common body to pursue a common end. There should be only one board of governance, one CEO, one strategic plan, mission or vision, at any one time.

5) Unity of command.

Orders should be received from one superior only. Decision making authority should flow in a straight line from the top to the bottom of the organization.

6) Unity of accountability and responsibility.

Authority is derivative of responsibility. Every employee, including the CEO, must be held accountable for the exercise of authority in executing his/her responsibilities.

7) Ownership needs.

A hospital board’s ultimate accountability is to the organization’s ownership.

8) Self-improvement and quality management.

Continuous improvement should be part of an organizational philosophy and should permeate all aspects of hospital management and governance practice.

9) Understanding the cost of governance.

Understanding cost of governance is about board members personal opportunity costs, direct board meeting expenses, the costs of staff supporting board activities, the costs associated with errors made by the boards, and costs of ineffectively structured governance-manage- ment-organization relationships.