Establishing well-organized and consistent governance processes and procedures enables the board to be most productive, and ensures that its time is allocated to the most critical topics. Agendas should reflect the most important strategic issues and priorities, and make efficient use of trustees’ valuable and limited time; meetings should be designed to maximize trustees’ ability to engage in critical dialogue; and committees and task forces should be used to enable the board to focus time on high-level strategic discussion. Agendas should not be so full and rigid that there is too little time for deep discussion and generative dialogue on the strategic issues that matter most to the organization’s future. One way to ensure that agenda items are necessary is to organize the agenda by strategic pillar or goal. If an agenda item does not fit well under a strategic pillar, it may not be appropriate for discussion at the board meeting.
Minimize Presentation, Maximize Discussion
Most board meetings include staff-led presentations on various topics and issues. In many cases, these presentations too often review information that trustees should be expected to digest and understand as part of their board meeting preparation. Informational reports should be synthesized into brief executive summaries that outline why the information is important and relevant to board knowledge and potential action. When appropriate, the summaries may include key considerations, options for discussion, and recommended direction from the CEO. In all cases, unless the information has some action attached to it, it should not consume valuable meeting time that can instead be spent on generative discussion and a focus on strategic thinking and planning.
Focus on Strategy
Boards of trustees must focus their time and energies on the most pressing strategic, future-focused issues and plan proactively and flexibly for rapid change and uncertainty. They must develop the expertise to recognize and solve longer-term issues, and ensure a synergy and consistency of activities and strategic direction. The structure and makeup of the board must mirror the organization’s strategic priorities.
Engage in Scenario Thinking
In today’s highly complex and rapidly changing health care world, there are no straight lines to the future. Boards must take the time to consider the many different possibilities of market change, driven by internal and external factors. One way to assess the impact of possible events is to predict various futures that may develop, and think through scenarios that reveal where the organization might be and what actions it might take should the scenario, or some version of it, occur. This can push the board to continually think into the future, and prepare thinking to anticipate future developments. Boards should then develop “dependent strategies,” or planned responses to different circumstances that may occur.
Focus on the Emergent
Boards can easily become overly focused on the here and now, and not devote enough strategic thinking to the future. Boards must continually adjust their focus to deal with the issues ahead, not the issues of the past. Creating time on the agenda for meaningful discussion of the most significant issues facing the hospital ensures that future issues, challenges, barriers and opportunities are considered. Time should be primarily focused on understanding trends and strategic priorities, rather than dealing with operational details; the focus should be on future-oriented strategic thinking about challenges and issues.
Miscommunication and misjudgment often are a result of inadequate listening. To ensure strong, effective governance communication, boards should acquire and absorb new ideas, listen attentively without rushing to judgment, and absorb information before offering a definitive response.
Stimulate Critical Conversations
Board and committee meeting time is limited, and every minute should count. Board members must ensure their governance conversations are always vibrant, vital, and focused on purpose and outcomes. Dialogue should be the board’s “social operating mechanism.” It is through holding critical conversations that decisions are made, grappling and grasping with concepts, ideas and practical solutions that lead to more informed and rational conclusions. Issues can be framed in advance by including generative-based strategic questions for discussion in pre-meeting materials.
Value Constructive Confrontation
Without constructive challenges to conventional wisdom and thought, the best solutions may never surface. Boards should regularly confront issues by challenging assumptions and exploring alternatives to traditional thinking. Doing so may cause short-term tension and disagreements, but this tension should be welcomed and resolved through thorough, organized, deliberative dialogue.
Listen to Disparate Voices
A well-informed board should search out opinions, ideas and perspectives that may be different from their own. Boards can accomplish this by listening to a variety of voices outside the organization and engaging the viewpoints of people with unique experiences and perspectives. Boards can stimulate conversations by playing devil’s advocate and assigning pro and con points of view to trustees in advance of board discussion to bring out disparate voices and minority opinions for consideration. In doing so, boards will expand their knowledge base, build a mutual understanding of diverse perspectives, and open new lines of thinking.
Adapt to Change
A turbulent environment requires organizations to be highly attuned and adaptable to change. Instead of reacting to changes, hospital boards must focus their thinking and be more proactive in their choices. Being proactive requires an “early warning system” that enables the board to address issues in a thoughtful, timely manner. When challenging situations arise, the board should bore below the surface to understand the root of what is actually occurring, so that the appropriate and most effective actions can be taken.
Too often the information that boards rely on to make decisions is anecdotal, disjointed or disconnected. The key to successful evidence-based decision making lies in the intelligent use of dashboards and balanced scorecards that plot performance against expectations over time. This enables the board to govern through strategic gap analysis, with attention focused where the most significant performance problems and opportunities lie. Recognizing patterns also extends beyond the use of dashboard or balanced scorecard tools, and is an invaluable competency for boards to be able to draw connections across areas of strategic dialogue. This type of pattern recognition may come from narratives and dialogue that lead to penetrating questions or key themes about root issues. While some trustees may already possess this competency, those who do not may be able to develop this leadership competency through the employment of a well-crafted and outcomes-focused mentoring process.