Many of the criticisms of American hospitals are implicitly charges of governing board failures. Boards cannot solve all the problems, but they can accept a mandate to guarantee quality and act more effectively to control costs. To succeed, they must stiffen their willpower (perhaps by better selection of their own members), broaden their knowledge base, and improve their decision processes. A clearer, more specific mission is a good start, backed by more reliance on the CEO, more collaborative relations with the medical staff, and more rigorous processes for planning and budgeting.