How Should We Structure Our Governance Committee?

Once your organization has developed its governance principles, the next question is how to put them into practice. That starts with defining the right committee structure so decisions happen at the appropriate level and involve the right people.

A mature healthcare governance model typically includes the following four layers:

Executive Steering Committee (ESC)

Operational Governance Committee (OGC)

Technical Governance & Architecture Review Board (ARB)

Department-Level Intake Committees (Recommended)

Each committee has distinct responsibilities and decision rights. Let's break down each committee and who should serve on it.

1. Executive Steering Committee (ESC)

The ESC provides strategic oversight, approves major investments, and resolves escalations that impact organizational priorities, regulatory readiness, or system-wide operations. The ESC isn’t an operational body but instead focuses on enterprise-level decisions.

Here’s a quick breakdown of who sits on that committee:

CIO or Chief Digital Officer
COO
Chief Facilities Officer/VP
Chief Medical Officer (or designee)
Chief Nursing Officer (or designee)
CFO or Finance Representative
Chief Compliance Officer
Chief Strategy Officer
EPMO/SPMO Director or VP (facilitator and consulted, nonvoting)

What are the responsibilities of the ESC?

Approve Tier 1 projects (as defined by the organization).
Approve regulatory, legal, and accreditation-driven work.
Approve capital-funded initiatives and major investments that impact IT, clinical operations, or enterprise systems.
Resolve conflicts between departments or service lines.
Pause, stop, or accelerate active projects when needed.
Validate portfolio alignment with organizational strategy.
Approve sequencing for major initiatives.

What about the EPMO and SPMO responsibilities?

The EPMO/SPMO serves as the facilitator and process steward for this committee, ensuring intake completeness, scoring consistency, packet quality, routing discipline, and accurate documentation of decisions. The PMO participates as a consulted, nonvoting member.

Can you use the ESC as the sole approval body?

Some healthcare organizations use the ESC as the only formal approval body for project requests.  While this can work in low-volume environments, it often leads to bottlenecks and inconsistent prioritization. In these cases:

The PMO should conduct operational and technical prescreening.
The ESC should focus on strategic, regulatory, and financial decisions.
Security, architecture, clinical safety, and other reviews should occur before ESC meetings.
As intake volume grows, the organization should consider establishing an OGC to improve throughput and decision quality.

This approach preserves executive oversight while making sure that governance is efficient and consistent.

2. Operational Governance Committee (OGC)

The OGC reviews and validates scoring, prioritizes operational and departmental requests, and manages sequencing and capacity across business and IT teams.

Here’s a quick breakdown of who is included on this committee:

IT Directors
Operational Directors
Clinical Operations Leader
Finance Representative
Security and Architecture (ad hoc)
PMO Leader and/or Portfolio Manager (facilitator and consulted, nonvoting)

What are the responsibilities of the OGC?

Review and validate scoring.
Approve Tier 2 and Tier 3 projects.
Recommend Tier 1 projects to the ESC.
Review portfolio health and capacity.
Identify conflicts, dependencies, and sequencing issues.
Route work to IT/ARB, security, capital, or clinical safety, as needed.

What are the PMO and/or Portfolio Manager responsibilities?

The PMO serves as the facilitator and process steward for this committee, ensuring intake completeness, scoring consistency, packet quality, routing discipline, and accurate documentation of decisions. Portfolio Managers participate as consulted, nonvoting members.

Larry Green
Principal Advisory Consultant
Executive PMO Strategist
Get in touch with me

3. Technical Governance & Architecture Review Board (ARB)

The ARB ensures technical feasibility, security, alignment with clinical workflows, and architectural consistency for all technology-enabled work. This committee provides technical governance across infrastructure, applications, integration, security, and clinical systems.

Here’s a quick breakdown of who is included on this committee:

CIO (or delegate)
CTO (or delegate)
CISO/Chief Security Officer (or delegate)
CMIO and CNIO (clinical technology oversight)
IT Operations Director (or delegate)
Enterprise Architecture SME(s)
IT Infrastructure Leader
Application Leaders (EHR, ancillary systems, digital, etc.)
Integration SMEs (interface, interoperability, API governance)
Data/Analytics Leader (optional)
IT PMO Leader and/or Portfolio Manager (facilitator and consulted, nonvoting)

What are the responsibilities of the ARB?

Approve technical design and solution architecture.
Validate security, privacy, and compliance requirements.
Ensure alignment with enterprise standards and road maps.
Identify technical risks, dependencies, and integration impacts.
Validate vendor solutions and technology selections.
Route items to OGC or ESC when decisions exceed technical scope.
Support PMO with technical input for scoring and governance packets.

What are the IT PMO and/or Portfolio Manager responsibilities?

4. Department-Level Intake Committees (Recommended)

The Department-Level Intake Committees (or a designated department-level leader) typically provide an initial review of requests before they enter the formal intake process. These committees ensure clarity, sponsorship, and alignment with departmental goals, reducing unnecessary demand on portfolio management and governance.

While Department-Level Intake Committees are not required, organizations benefit from using them (or a designated department-level leader) to prescreen requests before they reach the individual PMO(s) and Governance committees. This improves clarity, sponsorship, and intake quality; accelerates decision-making; prevents avoidable churn; and ensures that only well-defined, appropriately sponsored requests enter the formal intake and scoring process. This prescreening step improves intake quality but does not replace PMO triage or formal scoring.

Department-level prescreening is especially valuable in healthcare environments where intake volume is high; operational needs shift rapidly; and many requests are small, localized, or operational in nature. This structure makes sure that requests are reviewed by those closest to the work while maintaining alignment with enterprise intake standards.

Here’s a quick breakdown of who is included on this committee:

Department Leadership
Clinical Leads (if applicable)
Operational SMEs (consulted as needed)
PMO Leader or Portfolio Manager (consulted, nonvoting, as needed)

What are the responsibilities of the Department-Level Intake Committees?

Validate problem statements.
Confirm executive sponsorship.
Ensure departmental alignment and readiness.
Reduce noise and improve intake quality.
Identify whether a request meets escalation criteria.
Ensure only well‑defined requests enter the PMO intake process.

What are the IT PMO and/or Portfolio Manager responsibilities?

The PMO is consulted as needed to provide templates, best practices, and escalation guidance, but does not facilitate or oversee department‑level intake.

Now that you have a better understanding of how to structure each of these important committees, you are well on your way to developing a successful intake and governance model for your organization. But even with the right principles and committee models in place, intake and governance can still feel like a heavy lift without the right support.