quality in services and efficiency improvements (Eeckloo et al., 2004). These insiders might also play a more effective role in understanding and impacting clinical governance.
Both for-profit and non-profit hospitals in Lebanon seem to be running risks. For-profit institutions should move towards a more independent board and a direct representation of the medical professionals, coupled with an attention to risk management and patient concerns. Non-profit hospitals need to involve more direct stakeholder and community representation, and include board members with the medical expertise and knowledge required to lead and monitor a clinical governance initiative. The challenge remains for boards across both sectors to oversee a real change in culture to ensure proper clinical governance. The qualifications and independence of the board are crucial, but transparency, accountability, assessment and a thorough review of reporting procedures and appropriate follow-up are equally necessary.
Concluding remarks
An overview of the main observation and results indicates that Lebanese hospitals have some way to promote or enact a governance system that would comply with recommendations of best governance practices. There is no transparency in a real sense, and little protection of minority shareholders – or any of the stakeholders, for that matter. There is no real separation between ownership and control, or between control and supervision. Even those hospitals which presented better governance structures sometimes lacked the spirit of better governance or missed out on the details that would ensure objectivity and accountability on different levels. One of the main reasons why they lack good governance is that good corporate governance practices are still merely recommendations, and are not prioritized or assessed seriously in developing country contexts.
However, one should not ignore the nature of the Lebanese hospital sector, and the fact that it is far from being mainstream in corporate transactions, simply because the size of daily business is negligible in comparison to the healthcare business of well – developed financial markets. The trajectory for governance will depend on issues of ownership, expansion, market development and competitive initiatives. Although it is better to have general guidelines for a broad and comprehensive sound governance practice, some details should be kept hospital–specific, at least for the foreseeable future, and ownership and control should not undergo radical changes. The real driver for better governance should stem from the belief of hospital decision-makers that better governance would boost the performance would boost the performance the belief of hospital decision-makers that better governance would boost the performance of even family-owned hospitals, simply because better governance would help reduce costs and optimize operations, not to mention the favorable effect if would have on brand name and reputation in a fierce consumer-oriented market.
It is vital that the approach to better governance should not be crippling to a business, but should rather play a supportive role. Further research will help fine-tune the best practices for the hospital governance system. Last but not least, it is crucial that any introduced governance system revives in its value and recommendation the humanistic purpose of healthcare deliver, and draws a red line under ethical issues and social values that should never be lost in the quest for economic profits. In today’s world, all businesses, all businesses are expected to contribute in one way or another to society. Simply to be a non-profit organization is not enough for a non-profit hospital to be considered as fulfilling a social role, nor is it enough to be responsible in a reactive way. Hospitals should be proactive role models, Focusing on increasing awareness, promoting prevention, and holding community events relevant to medical issues.
At a time when the quality and safety outcomes of health institution are in the spotlight, and give the sensitive nature of services provided in this sector, calls for better governance and increased responsibility are unlikely to wane. Just the opposite: we expect more scrutiny and escalating expectation to which all healthcare institution (profit and non-profit making) will have to attend, in both developed and developing countries. The principles of corporate governance and corporate social responsibility developed in the corporate world do indeed provide a comprehensive frame of reference, to which the hospital sector need to give its own interpretation. Accountability, transparency, and responsibility are clearly the hallmarks of this system, the board of directors being the key engine or agent of change. As stated succinctly by Braithwaite and Travaglia (2008, p. 19), “at the end of the day, this is about working toward toward clinical and organization excellence. No board or executive group should want to settle for anything less”.