The formal justification/explanation of shifts in decision rights allocations during this period centers around a personality clash between the hospital director and the president of the ALSM.<sup>28</sup> However, careful analysis of data and minutes of meetings dating back to the years 1990-1993, combined with information obtained through structured interviews using the Decision Rights Analysis Framework, bring to bear a more complex picture. My analysis of decision rights reallocations, in particular, reveals that some of the roles the ALSM tried to take on (such as supervisory and management roles) were not tenable, despite the fact that they were necessary. These rights were not tenable because HDB did not have the middle management necessary to implement them, as will be explained in more detail below. Nor did some of the decision rights the ALSM tried to acquire square with the conventional functions of even the most aggressive of hospital boards. Interestingly, by 1993, the equilibrium reached at HDB was very much along the lines of the "corporate" board of a competitive hospital (summarized in Appendix A). The director was in charge of day-to-day decisions. The ALSM set the envelope for HR expenditures, discussed and cleared senior staff HR matters such as new appointments, bonuses and contract renewals and terminations.

On the other hand, my analysis of decision rights allocations also makes clear that some important functions were not adopted because the informality of the experience precluded their implementation. For example, while most boards can wield authority over the director partly because he/she is selected and employed by them, at HDB the situation was the reverse. The director had personally invited five of the seven members of the ALSM to serve on the board. Instead of being determined _ex ante,_ the distribution of decision rights between the ALSM and director was the result of negotiations that waned, but continued almost until the very end. Typically, in struggles between the director and the ALSM over decision rights allocations and the exercise of decision rights throughout the seven-year period, the informational advantage of the director dominated (Interviews with ALSM members). Also, this tenure was a long one by most measures, and it was fairly intense at the beginning and near the end -- periods of dis-equilibrium in decision rights allocations. As a result most members of the ALSM had progressively less energy and time to allocate to HDB, which led to their gradual ceding of many decision rights to the HDB manager, and ultimately to their departure once there was a cabinet reshuffle and a new Minister of Health was appointed. By this time, the ALSM was functioning more like a caretaker/benevolent board (see Appendix A). Very few important policies were initiated or implemented, despite the fact that they would have been desirable.<sup>29</sup> The departure of the Minister of Health at the end of 1996 coincided with the HDB director reaching retirement age and the appointment of a new director by the new Minister. These changes caused decision rights to be reallocated anew, a costly and tiring process, which accelerated the departure of 28 All ALSM members, including those who were party to the conflict gave consistent reports of this personality clash during interviews. There are a total of 28 references to organizational and restructuring initiatives recorded in the minutes of meetings, of which 8 are discussions of major hospital restructuring plans. These discussions were more frequent in the latter part of the experience.

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