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

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The GB doesn't have authority to make decision on incentives.

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Decisions made by GB have not implemented.

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Even though hospital employees have ethical problems, the GB cannot take action because its role has not been clearly stated.

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The role of GB in hospital should be stated clearly.

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It would be good if the role and responsibility of GB and hospital management had clear demarcation.

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What has been decided by the GB has not fully implemented.

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The role of GB in taking actions on hospital employees when problems arise within in the hospital is not clearly stated.

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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)

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The GB has been ordered direct procurement of drugs but the regional regulations did not allow that.

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The GB has limited authority to take corrective actions on employees. This is in the authority of civil service and health office.

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There is no autonomy; decisions made by the GB have been violated by the regional health bureau.

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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.

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Sometimes the regional economic and development bureau interfere in budgeting, which was the GB’s responsibility.

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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

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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.

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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.

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Most of GB members were high government officials; hence they do not give enough time to the GB committee.

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Most of the governing board members are high government officials [and] they don’t [dedicate] enough time to the governing board.

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The GB has not been meeting regularly.

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The GB has never met every month [as it was supposed to] based on the legislation.

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We have a shortage of time to monitor the hospital for we were busy.

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Community representatives have not attended meeting as needed because they have private businesses.

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The GB chair and members have been changed frequently.

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We have concerns that some GB members may not be able to attend board meetings.

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Inadequate payment for GB members.

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Small GB members’ payment.

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Little incentive payment to GB members.

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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

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The GB and RHB have to meet at least twice a year (inferring they do not).

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It would be good if the GB authority was limited and had been controlled by the RHB.

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[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.

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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

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Training should be given to GB members before they start work as GB members.

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Give adequate training to employees in order to help them provide the community with faster service.

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If GB members have received training on project designing… effective management style…how to give incentive to hospital staffs and retain them.

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If the GB could receive all of the above-mentioned trainings.

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[The GB needs] more capacity building training.

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We lack of knowledge on how to lead hospital services because the GB members are not trained.

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There should be orientation program for new GB members.

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Training giving time and place should be convenient to members.

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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

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If GB composition comprised more community representatives, [that would be better].

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It would be better if the GB composition comprised more community representatives.

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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.

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It would be better if the GB members were nominated from the district [more local] administration than from zonal administration.

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It would be better if the GB members for district hospital had been nominated from the district administration.

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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].

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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.