Abstract
The shift from local, community-based hospitals to more complex, multilevel delivery systems raises questions about the community accountability exercised by hospitals. A national sample of community hospitals is the basis of this study, which examines the ways that community accountability is exercised by the governing boards of hospitals affiliated with health care systems and how such institutions compare with hospitals not affiliated with a health care system. Results indicate that hospitals display community accountability in a variety of ways. Boards of system-affiliated hospitals exercise community accountability most strongly in their information monitoring and reporting activities, whereas free-standing hospitals exercise community accountability through the structural and compositional attributes of their boards. Further, hospitals affiliated with different types of systems vary in the style and degree of accountability they demonstrate.