Best Governance Practices: Not Just for Goliaths

by Mary K. Totten

Today’s hospital leaders know their trustees must be more adaptable, connected and knowledgeable about the changing health care landscape than any of their predecessors. But do they believe their volunteer community board is truly capable of stepping up to current field challenges? The trustees at Margaret Mary Health, a 25-bed critical access hospital and health system in Batesville, Ind., conclusively answer that question, shattering the myth that only large system boards can embody state-of-the-art governance.

“Health care reform gave us the impetus for governance change,” says Tim Putnam, Margaret Mary’s president and CEO for the past six years. “We knew we needed to go beyond doing better—we needed to ask ‘What does it mean to be a community hospital today?’”

Believing that more board education was the key, Putnam added more onsite learning sessions, bringing in American Hospital Association, National Rural Health Association and state hospital association materials and presenters. One speaker talked to trustees about diabetes in the context of the emerging value-based approach to care. “He said hospitals have never been paid to keep diabetes under control but one day they would be— and that should be their responsibility today,” Putnam says. That was an “a-ha” moment for the board in understanding population health management. “Now we ask why patients come in and how we can prevent it—we never had that conversation before.”

But the bigger “a-ha” that led to the board’s deeper transformation came in 2012 when Margaret Mary’s trustees attended an AHA Center for Healthcare Governance meeting. “We joined the Center to understand the value of what the board does as a whole—and decided to go as a full board to the meeting,” Putnam says. That gave the trustees a shared learning experience—and the opportunity to find out how other trustees were meeting their challenges. “Our trustees came back home energized and ready to embrace best practices … and they gave me my marching orders,” he says. To lead that quest for best practices, the board decided to more deeply empower its governance committee and chose trustee John Dickey as its “marching orders” chair.

“The community hospital board has two functions,” Dickey says. “To fulfill the organization’s mission and to make sure it goes on forever.” Those duties have become “a burning platform” since passage of the Affordable Care Act, he adds. With his background in organizational development, human resources and global operations, Dickey brought considerable public board experience to the Margaret Mary board and has approached his role as governance committee chair in much the same way.

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