What happens when you put one of America's leading healthcare governance experts in conversation with a veteran industry insider? You get a rare, unfiltered look behind the curtain of hospital boardrooms where life-and-death decisions get made every day.

Jamie Orlikoff, renowned governance consultant and active health system board member, joins host Nathan Kaufman to reveal the dramatic transformation of healthcare governance from ceremonial volunteer boards to professionalized leadership structures. With startling candor, Orlikoff explains that what once made hospital boards work—community connections and social relationships—now often prevents them from making necessary but difficult decisions.

The conversation exposes the paradoxes at the heart of American healthcare: hospitals becoming larger yet operating on thinner margins; costs rising for consumers while systems struggle financially; everyone demanding lower prices until it affects services they personally need. "Everybody hates hospitals until they need them," Orlikoff observes, capturing the fundamental tension healthcare leaders must navigate.

Most provocatively, Orlikoff reveals that only about 5% of hospital boards currently operate at the level of "best governance practices" needed to address today's healthcare challenges. The majority function at merely "good" or "normative" levels—an approach increasingly insufficient as financial pressures mount and quality concerns persist. With medical errors remaining the third leading cause of death in America, the stakes couldn't be higher.

You'll learn why more health systems are recruiting directors from outside their communities, why board compensation has become the norm rather than the exception, and why the traditional volunteer model is giving way to professional governance structures that can make tough decisions when necessary.

Whether you work in healthcare, serve on a board, or simply want to understand how hospital decisions affect your care options, this episode provides an insider's guide to the hidden power structures shaping American healthcare. Subscribe now and join us as we build bridges toward a healthier future.

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