Ukraine’s healthcare system is entering a new stage of managerial transformation. The Cabinet of Ministers of Ukraine has begun the formation of supervisory boards in medical institutions. It is expected that this instrument will strengthen transparency, strategic governance, and accountability of hospitals. This is not merely a formal institutional change, but the gradual implementation of a new governance model that has long been a standard for many public and municipal institutions in European Union countries.
The reform предусматривает gradual introduction of supervisory boards in medical institutions. From 2027, the presence of a supervisory board will become a mandatory condition for contracting with the National Health Service of Ukraine (NHSU) under the Medical Guarantees Program for cluster and super-cluster hospitals. From 2028, this requirement will apply to all institutions providing specialized medical care.
It is expected that the majority of votes in supervisory boards will belong to representatives of civil society — in particular organizations working in healthcare, anti-corruption activities, and veterans’ policy. In this way, the state attempts to separate strategic oversight from the operational management of hospitals.
A supervisory board is a body of strategic oversight that influences key decisions of the institution. Among its main functions are:
· strategic and financial oversight;
· approval of strategic and annual development plans;
· approval of financial indicators and KPIs;
· participation in personnel matters concerning the head of the institution;
· oversight of internal and external audits;
· regulation of conflicts of interest;
· development of integrity and ethics policies;
· oversight of compliance with the rights of patients and employees;
· approval of key internal documents — from bonus policies to the use of charitable funds.
It is important that decisions of the supervisory board within its competence are mandatory for the medical institution to implement. This means a significant strengthening of institutional control over hospital activities.
Historically, the Ukrainian system of managing medical institutions has been highly centralized and dependent on local authorities. In many cases, the hospital director simultaneously combined several roles: administrator, financial manager, and strategic leader. At the same time, mechanisms of external control were limited.
The introduction of supervisory boards aims to change this model by creating a balance between management and oversight.
Potential advantages of the reform
1. Increased transparency
The presence of an independent oversight body may reduce the risks of non-transparent use of funds, especially in large hospitals with significant budgets. This is also important for managing charitable contributions, procurement, and investment projects.
2. Strategic planning
Supervisory boards can help hospitals transition from short-term management to strategic development. This includes modernization of infrastructure, development of new areas of medicine, attraction of investments and partnerships, etc.
3. Strengthening public trust
The involvement of civil society organizations in governance processes may increase trust in medical institutions, especially regarding transparency and protection of patients’ rights.
4. Professional governance
If properly formed, supervisory boards can involve experts in finance, law, medicine, and management. This can improve the quality of management decisions.
At the same time, the reform is not without risks.
One of the biggest risks is the use of supervisory boards as an instrument of political influence. If the formation process is not transparent, there is a risk that members representing the interests of specific groups rather than the healthcare system will be appointed.
Another risk is a lack of competencies. Effective work of a supervisory board requires a high level of expertise. Members must understand financial management, the healthcare system, legal regulation, and risk management. Without this, the supervisory board may become merely a formal body.
As a result, conflicts with hospital directors may arise. This is another potential risk.
A clear division of powers between the hospital director and the supervisory board is critically important. If there is no clear governance system, conflicts may occur between the management team, the supervisory board, and the owner of the institution.
For hospitals, the creation of supervisory boards will mean new procedures, additional reporting, and the need to revise internal documents. For many institutions, this will become a serious organizational challenge.
For management teams of medical institutions, the reform means that preparation should begin now. It is not only about formally creating a supervisory board. It is necessary to:
· conduct an audit of the governance system;
· review internal regulations;
· update financial and personnel procedures;
· introduce ethics and conflict-of-interest prevention policies;
· prepare a transparent reporting system.
In fact, this is about transitioning to a new culture of governance in healthcare. The introduction of supervisory boards can become an important step toward modernization of the healthcare system.
However, the success of the reform will depend on three factors:
1. transparency in forming supervisory boards;
2. professionalism of their members;
3. clear separation of powers between management and oversight.
If these conditions are met, supervisory boards may become one of the key tools for modernizing hospital governance. If they become merely a formality or an instrument of influence, the system will receive another bureaucratic level without real change.
