A Governance Evolution Through System Affiliation

St. Lawrence Health evolved its governance structures and practices – ensuring local healthcare remained community-focused and coordinated – after it affiliated with Rochester Regional Health.

Background

St. Lawrence Health (SLH) was formed in 2013 between Canton-Potsdam Hospital and Gouverneur Hospital in upstate New York. It grew in 2019 with the addition of Massena Memorial Hospital. Then in 2021, SLH affiliated with Rochester Regional Health (RRH) to improve healthcare quality and efficiency in the North Country.

As is common when an independent hospital joins a larger healthcare system or when systems affiliate, governance responsibilities shift. Certain authorities like strategy and financial oversight are delegated to the system level, while affiliate hospital boards most commonly retain oversight of local quality, credentialing, and community health and benefit.

Challenge

As health systems expand and governance authorities shift, the new governance structures run the risk of become fragmented —what some describe as a “patchwork quilt” effect – which could lead to confused roles, inconsistent policies, time wasted, and misaligned priorities. Without intentional governance redesign, these inefficiencies can compromise decision-making, slow response times, and dilute an organization’s ability to address community health needs effectively.

Throughout its system affiliation journey, SLH leadership has recognized the need to evolve its governance structures to maintain efficiency and effectiveness, ensure alignment, and stay focused on fulfilling its mission.

Solution

To mitigate risks following the affiliation, the SLH board and executives have worked to align and operationalize governance, clarifying the role and authority of affiliate hospital boards—particularly in areas such as quality and ensuring local community health benefits.

SLH laid the foundation for great governance including:

Educating Board Members – Provided continuous governance education to ensure clarity in roles and responsibilities while reinforcing a strong focus on community health priorities.
Creating a Unified Governance Structure – Developed a governance model for community health oversight, reducing inefficiencies and accelerating decision-making.
Strengthening Board Operations – Streamlined governance processes by refining agendas, materials, dashboards, and self-assessments, elevating discussions and enhancing decision-making.
Aligning System and Affiliate Hospital Boards – Ensured that both system-wide and local boards worked in sync to identify, address, and advocate for community health needs.

At the same time—and throughout the entire process—SLH consistently emphasized the importance of addressing local health needs through partnership and collaboration with community-based organizations. This effort included:

Identifying and prioritizing key health needs such as chronic disease prevention, mental health and substance use disorder prevention, and maternal and infant health.
Assessing existing community health resources beyond the hospital setting, particularly those serving St. Lawrence County residents and focused on the three priority areas.
Engaging in dialogue and shared learning to better understand the systemic challenges and opportunities faced by residents in need, and also those faced by the community-based resources in providing services.
Exploring ways to strengthen service coordination and integration and promote partnerships and collaborations to drive better alignment, focus and community impact.

Results

Broadly, SLH’s governance enhancements have clarified its role in advancing community health and delivering community benefits. These improvements have strengthened oversight, accountability, direction, and decision-making—particularly in addressing systemic barriers to health.

More specifically, these efforts have led to collaborative and interconnected initiatives that support community health, including:

An updated and expanded Community Health Needs Assessment (CHNA) and Community Health Improvement Plan (CHIP) to address the top three priority health needs of St. Lawrence County residents.
Initiated a Community Resources/ Care Network Task Force to enhance organizational collaboration and alignment.
Established a partnership project with Clarkson University to address critical transportation barriers impacting patient access to care in rural and underserved areas.
Invested in SLH mobile integrated health – A mobile team that provides community-based medical care, services, and support directly to individuals in the community.
Increased investment in advancing care coordination by connecting non-Medicaid patients with community-based organizations (CBOs) in the region.
Meaningful participation in New York CMS 1115 Waiver initiatives.

In addition to these initiatives, strong and effective governance enhances public trust, strengthens organizational integrity, and ensures greater alignment with community health priorities for greater overall impact and use of resources. A robust governance structure also helps mitigate regulatory risks, amplifies local health initiatives, and supports more strategic allocation of resources—ensuring that healthcare investments effectively address the evolving needs of the communities SLH serves.

Conclusion

Governance effectiveness is not just an administrative necessity, it’s a strategic imperative for healthcare organizations navigating growth, system affiliations, and increasing public and regulatory scrutiny. SLH’s governance model serves as an example for other newly affiliated, nonprofit health systems seeking to maintain both operational efficiency and a deep commitment to the communities they serve.

WitalisLLC

A healthcare governance company