This case provides an introduction to the structure and dynamics of nonprofit hospital governance in the U.S. A hospital CEO two years into her position is grappling with how to make her board a more effective governing body. The hospital’s competitive position was eroding due in part to resistance by its independent medical staff to recruiting new physicians into the service area. In addition, some of the physicians had opened freestanding diagnostic and treatment facilities that reduced hospital revenues. But the board was reluctant to take this issue on. At the same time, the CEO felt that too much board attention was spent second-guessing her new hires and other operational decisions that she felt were her responsibility.