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November 17, 2022
David W. Johnson
Outcomes System Dynamics

O Nonprofit Governance, Wherefore Art Thou?

The “Keckley Report” from October 31, 2022 zeroed in on three blind spots that plague governance of nonprofit hospitals and health systems. First, boards are not paying enough attention to organizational culture. Second, they do not understand and are not monitoring their competition. Third, they have lost track of purchaser attitudes and beliefs.

Paul and I are featured columnists for HFM Magazine. His incisive opinions about good and bad organizational governance dovetail with my own. With this in mind, 4sight Health has compiled the following three articles on nonprofit governance of hospitals and health systems.


The Three Blind Spots in Hospital Strategic Plans

Paul Keckley’s insightful “The Three Blind Spots in Hospital Strategic Plans” that I referenced above. Read more. 






Cracks in the Foundation: Overcoming Inadequate Leadership

The final article in my six-part “Cracks in the Foundation” from HFM Magazine titled “Overcoming Inadequate Leadership.” Read more.






Dynamic Tension: Rethinking Health System Governance

My 2017 article coauthored with former Providence CEO, Dr. John Koster. It’s titled “Dynamic Tension: Rethinking Health System Governance.” Read more.




These are dangerous times for healthcare providers. Inpatient volume is soft. Payer mixes have deteriorated. Labor and supply costs have skyrocketed. New competitors are stealing market share. Government and commercial insurers are not riding to the rescue. Asset-heavy platforms have become a liability. Negative media has proliferated. Indeed, we may be witnessing the beginning of the collapse of the nonprofit health system business model.

Given the stakes, this is a time for decisive leadership from boards with engaged and expert members who are fully vested in organizational positioning and risk-taking. This isn’t happening enough. The three articles above provide concrete suggestions for improving organizational governance at this time of critical need.

This compilation’s title riffs on the famous balcony scene from Shakespeare’s “Romeo and Juliet.” Juliet’s plaintive plea, “O Romeo, Romeo, Wherefore Art Thou Romeo” is among the most misunderstood lines in literature. She is not asking where Romeo is. She is asking why their current circumstances prevent their being together.

Nonprofit boards should also be asking why: why current circumstances prevent the hospitals and health systems they govern from providing the value-base services that Americans need, want and desire. Leadership begins at the top. Change is necessary. Let’s get it done.

About the Author

David W. Johnson

David Johnson is the CEO of 4sight Health, an advisory company working at the intersection of healthcare strategy, economics, innovation. Johnson is a healthcare thought leader, keynote speaker, and strategic advisor to organizations busting the status-quo to reform our healthcare system. He is the author of Market vs. Medicine: America’s Epic Fight for Better, Affordable Healthcare, and his second book, The Customer Revolution in Healthcare: Delivering Kinder, Smarter, Affordable Care for All (McGraw-Hill 2019). As a speaker, Dave plays the role of rebel, challenger, industry historian, investor and company evaluator to push audiences forward. (Watch bio video.) Johnson applies his 25+ years of investment banking in healthcare to identify ways the healthcare industry must change to deliver better care. He received a Masters in Public Policy from Harvard Kennedy School, an English degree from Colgate University, and served in the African Peace Corp service. Join over 10k+ healthcare executives who read our weekly insights and commentary on www.4sighthealth.com. His third book, Less Healthcare, More Health: The Prescription for a Happier, More Equitable and Productive America, will publish in 2024.

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