The key to a successful relationship with your CEO

During the course of my 50-year health care management career, it has been my experience that the most successful CEOs maintain an effective working relationship with their board.

The main lesson I have learned as a CEO for nearly 20 years is that governance success happens when the CEO and the board share mutual respect and the ability to be candid, honest and open about decisions. You can hire the CEO with the best leadership and management competencies, but he or she will perform significantly better when there is an ongoing positive relationship with the board.

Building and maintaining an effective working relationship begins with the CEO and board members agreeing on each other’s roles and responsibilities. This doesn’t have to involve a great deal of discussion but should reinforce that the CEO is responsible for implementing work to address the goals and policies that the board creates.

The CEO’s role is to report back to the board the successes and failures of work related to those goals and policies and to seek the board’s input in areas where the CEO has been unable to achieve desired outcomes. This may seem as though I’m advocating that the CEO give up some responsibility — I’m not — but the CEO should collaborate with the board to open doors that only trustees can to pave the way for improved performance.

Honest discussion

Although it is the board’s responsibility to set goals and policy, it should do so jointly with the CEO to better support strategies to move the organization in the appropriate direction. The board-CEO relationship may seem complicated on the surface, but it can be straightforward when mutual respect, honesty and openness exist, especially when it comes to decision-making.

The CEO and board may not agree on every issue. That’s perfectly acceptable as long as an open conversation leads to the clarity necessary to achieve an outcome that makes the organization better.

Sometimes, achieving that kind of clarity requires careful consideration and soul-searching. For example, several years ago my organization hired a physician who retired from independent practice. Later, the physician was recommended for a board opening. Having a board member who is also an employee of the hospital can be a difficult situation for a CEO and requires compliance with Internal Revenue Service, conflict-of-interest and other requirements. Never considering an employee for a board seat, though, can result in passing up someone who would be a phenomenal trustee.

The physician had all the right talents to also serve on the board. The board and I thoroughly and honestly considered whether it made sense to give the employed physician this new responsibility. It turned out to be one of the best decisions we ever made, because the physician board member was able to keep his two roles distinct.

Achieving clarity

We can foster an open, honest relationship in other ways as well. For example, in advance of our monthly board and committee meetings, the board and I review the highlights of the agenda so that trustees, especially newer ones, can ask questions. This can help remove preconceptions anyone may have, and gets to the substance of the decisions that will be made and how they can be executed, all before a meeting takes place.

One instance of this took place recently when the hospital considered offering a procedure to patients with a specific disease. Some board members wanted to ask whether it made financial sense for the hospital to perform the procedure, because of its high costs and the disease's prevalence. They didn’t want to be seen as not supporting the hospital's role as a strong, full-service facility, and they didn’t want it to appear as if they were against treating patients with the specific diagnosis. Once we addressed the question in advance, board members could either support or not support offering the procedure, doing so with a better understanding of the implications of their decision.

Finally, our open and honest relationship also helps board members feel comfortable sharing with me the community’s concerns and positive feedback. This strengthens our hospital’s ability to serve our community even more effectively.

Raymond V. Ingham, Ph.D., FACHE (ringham@witham.org) is president and CEO of Witham Health Services in Lebanon, Ind.