So boards have some catching up to do in understanding the role of their in-house staff, the report says.

The hospital has an attending physician staff of 1,800 and an in-house staff of more than 5,000.

The research project was conceived as a collaborative one, with in-house staff co-ordinating the work of nearly 10,000 contributors internationally.

In addition to in-house staff, the company employs virtual workers who work remotely through an extranet and virtual private networks.

Many minor roles, including incidental and crowd voice work, were filled in by the in-house staff.