Restructure Board Meetings to Create More Engaged Trustees

What if the typical hospital board meeting — multiple hours spent on endless pages of financial data, slide after slide of bullet points and little time left for meaningful discussion — could be more engaging and less time-consuming? With some planning and practice, boards and senior executives can make this happen.

At Texas Health Resources, a 24-hospital system in the Dallas-Fort Worth area, we’ve taken a different approach to agenda planning and board presentations that allows us to spend more time in discussion and less time on routine reporting. First, we put action items early in our agendas to ensure thoughtful consideration and a quorum when voting, rather than later in the meeting when trustees become tired and less attentive or need to leave. Action items are followed by discussion, routine retrospective reports and finally, an executive session. We specify times for each item on the agenda to hold people accountable for staying on track.

Streamlining the process and cutting down on presentation time has increased discussion of our most important topics at board meetings. This meeting style has resulted in more engaged, productive board members.

10 Presentation Tips

Creating an effective meeting agenda is only half the battle. Presentations delivered during meetings also may need improvement. These 10 tips for presenting information to trustees are based on my research and 30 years’ experience in observing and planning board meetings. By incorporating these tips, you’ll be able to transform your board meetings so that trustees are more engaged and their time is well-spent.

1. Plan and prepare — don’t wing it. Start the planning process by outlining the key points and determining what the board should take away from the presentation and the information they need to know. Developing a presentation this way is a difficult, but crucial exercise. It forces presenters to crystallize their messages. Additionally, practicing the presentation is essential.
2. Include an executive summary in the board packet. List key points only on slides. Remember, the speaker — not the slides — is the presentation.
3. Get to the point in one minute. Board members typically hear many presentations during a meeting, so they need to understand quickly what they should focus on for each one.
4. Don’t read slides to the board. Most people have not enjoyed being read to since childhood. Presenters should add color commentary, examples and perspective, using a narrative format when possible.
5. Apply the 20/20/60 rule in constructing presentation content. This means the content should be:
   • 20 percent about the topic
   • 20 percent about why it is that way
   • 60 percent about what you’re doing about it
   For example, the latest dashboard indicates a drop in patient experience performance over the past quarter. Telling the board that this occurred and that senior leaders are working on it is insufficient. Instead, explain what happened, the root cause analysis conducted and what it revealed about the underlying reasons for the change. Most importantly, explain action plans to get back on track.
6. Lead with stories and analogies, not data. There’s no reason presenters can’t weave data into their stories but, in general, people are more attentive when listening to narratives than when they are presented with a recitation of facts or data. Stories bring a topic to life. They enable board members to relate to and better understand the material. For example, instead of reading lines of numbers, the chief financial officer could make financial reports more meaningful by presenting the information in a narrative format, explaining the key factors that contributed to the current positive or negative performance, action plans to either sustain or correct the pattern, and expectations for performance for the short- and long-term horizons.
7. Paint a simple picture that doesn’t overwhelm. Health care executives frequently make the mistake of presenting the same reports to the board that they present to each other. Instead, executives need to keep the board audience in mind and deliver a higher level, less data-intensive report that highlights key takeaways and illustrates main points boldly. The reports should tell boards what they need to know and delineate the requested actions.
8. Focus on the current time period and highlights or key variances. For example, discuss year-to-date and current month data, not data from the past two months. At Texas Health Resources, many of our boards meet bimonthly. It would be inefficient to review two months’ worth of data. Instead, we focus on the current situation and year-to-date performance. Board members can refer to their board packets for additional detail.
9. Conclude with key takeaway points. It should be clear to the board why they needed to hear this presentation. Begin and end with key takeaway points.
10. Do not exceed allotted time. Prepare to deliver the presentation and leave time to answer questions without rushing or delaying the rest of the agenda.

Steer Clear of Traps

Avoid common pitfalls by being mindful of potential barriers to great presentations and structuring effective board meetings. For example, all boards have to meet regulatory and accreditation requirements, but these topics don’t need to dominate meetings. Ensure that presentations focus on a mix of topics that allow board members to engage in different ways — some designed for informational purposes and others set up and stimulate strategic discussion.

Another potential challenge occurs when a few trustees intent on talking about a topic interrupt a presentation and dominate the discussion. This makes it difficult to get through a presentation, and it can take time away from other presentations and topics that need board attention. It’s important to balance the time allotted to all agenda items, with the board chair managing the time spent on each topic throughout the meeting.

Board members participate in meetings at a variety of levels, so it’s imperative to devise creative strategies to ensure that they all weigh in on key agenda items. Consider approaching less active board members in advance of a meeting to let them know that the board will be talking about a certain topic in which they have an interest or expertise. This gives them an opportunity to think about how they can contribute. Then, the chair can plan to call on these board members before the more talkative members jump in, or he or she can ask each member around the board table to share thoughts and perspectives.

Boards should continually look for opportunities to transform their meetings and better engage their members. Simple steps, such as spending less time on retrospective reports and making sure presentations are concise and tailored to the audience can help good meetings become even better. Agenda management that places strategic and prospective discussion topics before routine or retrospective presentations is the key. The goal is not to save time; it is to engage board members in meaningful discussion. 

Luanne R. Stout, M.H.A. (LuanneStout@TexasHealth.org), is chief governance officer of Texas Health Resources, Arlington.

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