Hospitals are of critical importance to contemporary health systems in developed countries, providing essential medical services and leading the development of increasingly complex interventions. From a public policy perspective, ensuring that hospitals are well-managed and meet the needs of their patients is of indisputable importance, both for patients (particularly under the conditions of universal health coverage) and for policy-makers. That said, the precise mechanisms through which the activities of hospitals are determined can be opaque, particularly to patients and potential patients. The direct involvement of patients and public in hospital governance is one solution to this opacity. In this dissertation, public and patient involvement is examined in the context of elected representatives who are part of the management and governance of large, semi-autonomous publicly funded hospitals in the UK. Specifically, this project examines a tertiary-care research-linked hospital that delivers services funded by and on behalf of the National Health Service England. This project represents a novel contribution to understanding public and patient involvement by using ethnographic observation and direct recordings of closed and hitherto undocumented (in the sense of ethnographic research) governance and management processes in a case-study hospital. This dissertation also demonstrates the relevance of conceptualising the hospital in terms of clinical knowledge and expertise which delineates the medical domain from the non- medical. Through the examination of specific episodes of patient and public representative participation in governance, this dissertation argues firstly that the ‘governance’ should be understood by and through the actions of participants in such processes, and that examination of the actions of governance actors (including public / patient representatives and hospital management) suggests a novel interpretation of health financing as a common pool resource. This in turn forms the basis for a critique of the imposition of economic and management incentives designed predominantly for profit- seeking firms onto public service providers.