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The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide evidence-based guidance to countries that are reforming their public hospital governance structures in line with best practice.

The paper uses the structural dimension of Cooper, Fusarelli and Randall’s policy model and institutional theory to review the legislative frameworks of four model countries supported by extant literature.

The paper conceptually distinguishes health system governance and organisational governance in the health system. It further visualises the emerging alternative legislative models of organisational governance and a hierarchy of governors applicable to public hospitals.

The paper provides critical knowledge for understanding organisational governance within health system governance framework and develops tools that can be used in reforming institutional mechanism of organisational governance of public hospitals.

The purpose of this paper is to explore the nature of governance reforms also called conceptual innovation for public hospitals in Malawi.

It focuses on the reforms for central and district hospitals. It uses semi-structured interviews to collect data and thematic approach to analyse it.

The results show that the reforms for central hospitals are structurally well characterised as aimed at corporatisation though they are termed as automatisation. The terminological seems not to pose any harm on the direction of the reforms due to the thorough structural characterisation. On the other hand, reforms for district hospitals are vague as such implementation is retrogressive, in that, instead of progressively moving the hospitals towards greater autonomy the opposite is happening.

The paper highlights the significance of characterisation of the intended outcome on the direction of the reforms and proposes a framework to guide conceptual innovation for public hospitals in a devolution-mediated environment.

Sound organisational governance does not occur naturally; it is a product of effective awareness. This study aims to examine the level of governance awareness among public hospitals' governance actors in Malawi.

The study uses semi-structured interviews to collect data that are analysed thematically.

The study found that governance awareness among the actors was low. Although the majority of the actors displayed a broad perspective, they, however, failed to clearly affirm the nexus of the governing organs – hospital board (or its equivalent) and hospital management. Furthermore, most were not aware of the existence of the country's self-regulatory framework for organisational governance. A possible compounding factor to the low level of awareness is their educational background that hardly recognises organisational governance as an essential component of their professional identity.

This is the first study to explore in-depth governance awareness in the context of public hospitals in developing countries. It highlights the need to develop strategies for creating effective governance awareness amongst the actors, which is often overlooked when carrying governance reforms.