The Governance Institute Releases Falling Behind Report, Warning Health System Operations Are Advancing Faster than Governance

SCOTTSDALE, Ariz.--(BUSINESS WIRE)--Apr 27, 2026--

The Governance Institute (TGI), a service of NRC Health, today released Falling Behind: Health System Operations Are Advancing Faster than Governance, a new governance brief examining whether today's health system governance models are keeping pace with the scale, complexity, and speed of modern healthcare.

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The report was released during TGI's 250th Leadership Conference in Scottsdale, Arizona, where healthcare trustees, executives, physician leaders, and governance experts are gathering under the theme, "A defining moment for healthcare governance."

Falling Behind argues that U.S. healthcare has outgrown the way it is governed. A shrinking number of boards now oversee larger, more interconnected systems, while artificial intelligence, federal policy shifts, workforce strain, reimbursement pressure, market disruption, and rising expectations are increasing both the complexity of decisions and the stakes of getting them wrong.

"This is not a critique of boards. It is a recognition that healthcare has advanced faster than the governance model supporting it,” said Steve Kett, Chief Executive Officer of The Governance Institute. “Boards are deeply committed, but commitment alone is not enough. Governance must now be designed, developed, and supported as a core enterprise capability."

The report highlights several data points that underscore the scale of the challenge:

The report further identifies two major consequences of the governance gap: degraded decision quality and weaker feedback across complex health systems. When boards lack the structures and information flow needed to integrate decisions, issues such as quality, workforce, finance, strategy, risk, digital transformation, access, and mission can be considered in silos rather than as interconnected enterprise decisions.

Introducing the Governance Trilogy™

Falling Behind introduces TGI's Governance Trilogy™, a practical maturity framework designed to help boards identify the governance capability they have built and the capability they need next:

Next step: Blue-Ribbon Committee on Health System Governance

TGI also announced that it will convene a Blue-Ribbon Committee on Health System Governance this summer. The committee will bring together experienced trustees, health system leaders, clinicians, governance experts, legal and regulatory advisors, capital markets perspectives, and innovation leaders to inform the next phase of governance practice and revitalize TGI's board assessment approach.

Click here to read the full report.

About The Governance Institute

The Governance Institute, a service of NRC Health, provides trusted, independent information, resources, tools, and solutions to board members, healthcare executives, and clinician leaders in support of their efforts to lead and govern their organizations. TGI supports not-for-profit hospital and health system boards through research, publications, conferences, assessments, education, and advisory services.

About NRC Health

For 45 years, NRC Health (NASDAQ: NRC) has led the charge to humanize healthcare and support organizations in their understanding of each unique individual. NRC Health’s commitment to Human Understanding helps leading healthcare systems get to know the patients, families, consumers, employees, and communities they serve on a human level. Guided by its uniquely empathic heritage, human-centered approach, unmatched national market research, and emphasis on consumer preferences, NRC Health is transforming the healthcare experience, creating strong outcomes across the healthcare journey.

The organization recently received the 2026 Best in KLAS Award for Healthcare Experience Management, independently validating NRC Health’s relentless pursuit of excellence in healthcare through innovation and deep partnerships that bring together its comprehensive experience management platform, advanced technology, and proven techniques to drive the most human healthcare experiences.

For more information, email info@nrchealth.com or visit www.nrchealth.com.

"NRC Health's work is grounded in the belief that better understanding drives better decisions,” said David Burik, Executive Vice President, Strategic Insights for NRC Health. “This report extends that idea into the boardroom. The next era of healthcare requires governance that can listen across the enterprise, integrate what it hears, and act with confidence."

The Governance Institute (TGI), a service of NRC Health, today released Falling Behind: Health system operations are advancing faster than governance, a new governance brief examining whether today's health system governance models are keeping pace with the scale, complexity, and speed of modern healthcare. The report was released during TGI's 250th Leadership Conference in Scottsdale, Arizona, where healthcare trustees, executives, physician leaders, and governance experts are gathering under the theme, "A defining moment for healthcare governance."

GENEVA (AP) — The daughter of a former president of Uzbekistan went on trial in absentia Monday in Switzerland in connection with alleged bribery and money laundering involving assets worth hundreds of millions of dollars.

Gulnara Karimova, the daughter of former President Islam Karimov, is behind bars in Uzbekistan as the trial opens in a Swiss federal criminal court in the southern city of Bellinzona. It's set to run through May 22.

Swiss prosecutors say Karimova developed and ran a crime ring known as “The Office” that involved several dozen people and multiple companies. She is accused of depositing hundreds of millions of dollars’ worth of funds “of criminal origin” in Switzerland and abroad, and arranging for safe deposit boxes for the deposit of cash, jewelry and other valuables of criminal origin, the prosecutors said.

Grégoire Mangeat, one of her defense lawyers, said in an email that Karimova was being prevented from leaving the “prison colony” where she has been detained in Uzbekistan to attend the trial.

“We will seek the full and complete acquittal of Gulnara Karimova,” he said.

Uzbek news outlet Podrobno described Karimova’s presence in the Swiss courtroom as “virtually impossible” as the 53-year-old was already serving her sentence in Uzbekistan.

It said that Karimova had been moved to a women’s penal colony in Uzbekistan’s Zangiota region, on the outskirts of the capital, Tashkent, in early 2025.

Karimova was indicted three years ago in Switzerland along with a former director-general of the Uzbek subsidiary of a Russian telecommunications company for crimes allegedly committed between 2005 and 2013.

That was during her father's tenure. He led the Central Asian country for over a quarter-century until his death in 2016. Karimova had previously worked in Geneva in connection with the United Nations, and benefited from diplomatic immunity.

Karimova has faced a series of trials after a first conviction in Uzbekistan eight years ago, and is serving a 13-year sentence for organizing a criminal group, extortion and embezzlement.

In November 2024, Swiss prosecutors announced the indictment of Swiss private bank Lombard Odier and a former employee on allegations they had a “decisive role in concealing the proceeds of the criminal activities of ‘The Office.’”

Lombard Odier, in an email, said the prosecutor doesn't allege that the bank knowingly or intentionally engaged in money laundering, “but rather raises claims relating to alleged organizational shortcomings in prevention measures, which the bank firmly contests and will defend in court.”

FILE - Gulnara Karimova arrives for the screening of the film "The Exodus - Burnt By The Sun 2", at the 63rd international film festival, in Cannes, southern France, on May 22, 2010. (AP Photo/Matt Sayles, File)