AHA National Governance Report: 8 Key Insights

As health care environments evolve, hospital and health system boards must adjust their composition and practices to support innovation and overcome the various challenges providers face. With the release of the AHA’s 2025 National Governance Report, health care leaders can ascertain how their operations compare to nationwide trends as well as gain expert insights into potential opportunities for improvement.

Building on data included in previous governance reports and survey responses collected from August to December 2024 from the CEOs of 1,059 U.S. hospitals and health systems, the report offers a snapshot of health care governance structures and practices across the country. It covers board composition, structure, selection, culture, evaluation, performance oversight and orientation and education. Additionally, each of the report’s three sections includes commentary from governance experts to put the survey findings in perspective, adding a valuable layer of interpretation and analysis to the data.

8 Key Health Care Governance Trends

Based on the survey results, here are some notable trends in U.S. health care governance:

1. Board Make-Up: Hospital and health system boards increasingly include members from outside their service area who aren’t from sponsoring organizations or other system/hospital entities: 31% of survey respondents reported inclusion of outside members in 2024, compared to 26% in 2018.
2. Board Size: The average health system board size decreased from 16 voting individuals in 2014 to 14 in 2024.
3. Compensation: Health system boards increasingly compensate members: The portion who reported doing so rose from 25% in 2018 to 35% in 2024.
4. Age: Most board members are between the ages of 51 and 70.
5. Decison-Making Tools: The most utilized key performance indicators boards rely on include clinical quality (91%), patient safety (89%) and service quality/patient satisfaction (88%).
6. Time Allotment: Nearly half (47%) of health system boards surveyed said their members spent more time on board-related work and activities in 2024 than they did three years prior.
7. Orientation Process: Most survey respondents (81%) — including health systems, subsidiary hospitals and freestanding hospitals — reported having a formal orientation process for new board members.
8. Succession Planning: Only 40% of survey respondents said they did not have a formal CEO succession plan, down from 49% in 2018 and 55% in 2014.

This resource is free for AHA members and available for purchase for non-members. Explore the full report.