Competency Based Governance Enters the Health Care Boardroom

© 2010 Center for Healthcare Governance


The role of a health care organization trustee is getting more complicated and more sophisticated every day. Pressures are increasing simultaneously for higher quality, lower cost, more transparency and accountability, and use of evolving and ever-more-expensive technology. At the same time, hospitals face increasing competition from unexpected sources both for patients and for professionals in critical disciplines. Health care reform legislation has been enacted, but its implications for every dimension of the industry and its stakeholders are as yet unclear.

Buffeted by change on nearly every front, and in the face of unprecedented ambiguity and financial instability, trustees are faced with the need to make and endorse complex decisions that have long-term consequences.The challenges are often beyond those for which any amount of health care governance experience could have prepared them.

Competencies and Culture Travel Together

In the face of such conditions, the competencies of individual trustees and the culture that they build within their institutions are emerging as critical variables that differentiate the highest-performing health care organizations from the also-rans. Leadership culture reflects the values and norms within which the board of trustees and the leadership team of the organization operate—their compass and guide for decision-making and day-to-day behavior. Culture is shaped by shared behaviors which are, in turn, shaped by trustees’ individual competencies, expectations, and interactions.

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