This presentation introduces hospital governance and management concepts related to autonomy. It covers the rationale for hospital autonomy, presents a framework for understanding different autonomy models, global cases involving autonomy reform and lessons learned. Some of the main lessons learned include: autonomy is often a prerequisite to improving management; autonomy requires strong accountability mechanisms; and managers must be empowered to respond to incentives set in autonomy agreements. Aceso Global CTO Gerard La Forgia delivered this presentation at the Hospital CEO forum in Manila, Philippines, organized by the Asian Development Bank, in July 2018.