Board Culture

Get Active in Preventing Board Chair Burnout

Start with a well-defined role, delegation and limits on expectations

By Jamie Orlikoff

First reported among frontline care givers in the emergency department and ICU, pandemic-related burnout spread to impact nearly everyone in the hospital and health system. Burnout quickly entered the C-Suite, and drove unprecedented turnover as retirements, resignations and terminations surged. But burnout did not stop there, it next came knocking at the board room door.

The many stresses and challenges of the pandemic took on unique characteristics as they permeated the board rooms of the nation’s hospitals and health systems. Crucial, unprecedented and incendiary issues and decisions pummeled boards, as did the expressions of restive disaffection and even anger from their previously supportive community member. Confronting rationing decisions, vaccine mandates, the politicization of health care, overwhelmed staff and capacity, closed services, financial free falls, CEO turnover, turmoil in the labor markets and the demonization of hospitals, boards were challenged as never before. These tensions and pressures combined with spiking time and energy demands to generate burnout in the boardroom.

Defining Burnout

Although board member burnout is difficult to define precisely, it can include a progressive change in a trustee’s attitude and behavior that adversely affects the quality of involvement in, and enjoyment of, serving on the board. There are different levels and expressions of burnout in the boardroom, but one profound indicator is currently seen in the number of boards reporting difficulty in finding a sitting board member willing to serve as the next board chair.

Expectations, accountability and time demands on hospital and system board members have been sharply growing for years, but the pandemic both magnified these previous board stressors and added many new ones. These governance challenges impacted the entire board but none more so than the board chair, who also had to contend with maintaining board cohesion and significant increases in time demands. Having witnessed this, fellow board members are now expressing reluctance to seek or accept the position of board chair.

Reasons for Burnout

There has reportedly been a growing concern among boards that “No one wants to be the next board chair.” Together with incumbent board chairs who have held office during the pandemic desiring to end their tenure, this poses a new risk to effective board leadership succession.

When asked why they are not interested in serving as the next board chair, common concerns expressed by board members include:

• The job requires too much time and too much work, especially now as demands and pressures on the board are greater than ever.
• The job comes with great risk to my reputation and could put me in awkward and challenging positions in the community where I live and work and hope to remain.
• I do not feel properly prepared, and it does not seem as though there is significant training or support for the job.
• I do not know what the job of board chair fully entails, but it sure seems more than I thought.
• There are no rewards or recognitions that are worth the effort it takes to be chair – I am happy to just stay on the board or maybe chair a board committee.
• When I was recruited to the board no one ever said that I would have to serve as chair.
• The current board chair has not groomed any successor.
• Our board was really frayed during the pandemic, and the board chair jumped in with both feet. Is it really the job of the board chair to hold the board together in addition to everything else? That seems a bit much.
• I was told that it is “my turn” to be board chair; that is a stupid way to choose the board leader!
• I trust the current board chair and he or she is doing a great job and should just continue on in the job.

A significant part of a board’s effectiveness depends upon the quality of the board chair. It is a flashing red warning sign of board burnout and decline in effective governance if there are few or no willing candidates for the position of board chair. Thus, it is incumbent upon boards who are experiencing this issue, as well as those who sense warning signs of its impending arrival to actively confront it. To do so, consider some of the following strategies and approaches for both preventing board chair burnout and building continuity in the position.

Strategies to prevent burnout

Define the job with a written job description. No one can competently chair a board, or honestly consider accepting the job without first understanding what the job entails and what it does not. Without a clear, written position description, the chair is left to their own devices to figure out the responsibilities and time required for the job. To a potential candidate, the absence of a job description combined with recent “all hands-on deck” pandemic efforts can easily be viewed as a black hole of limitless time and work demands. A good board chair job description clarifies the expectations of the job, defines its roles, responsibilities and authority, and establishes parameters of the time commitment to perform the job based on experience of past board chairs. It can be used to select and orient potential board chairs, as well as the basis for board chair evaluation pursuant to term renewal. For board members, it takes the mystery out of the job and provides a basis for honest self-reflection regarding their ability and desire to do the job.

Implement term limits for the position. Term limits for the board chair position contribute to good governance in many ways. Term limits force a board to engage in ongoing, meaningful board leader succession planning as turnover in the chair position is always coming, with a certain end date for the current chair’s tenure. This in turn requires a board to develop its members into potential board leaders, and further, to regard “potential future board chair” as a competency-based selection criterion for new board members, thus building a strong bench of potential future board chairs. Further, it puts a time limit on the work required, as opposed to an open-ended commitment for a potential board chair that the lack of term limits strongly implies. Term limits also help create a board culture where the expectation is that many board members will be called on to serve a term or two as board chair. Without term limits chair turnover is sporadic and unpredictable, which means there will be no consistent or effective board chair succession planning processes. Also, boards that do not limit the term of the board chair run the risk of declining or dysfunctional leadership, and of demoralizing board members who become frustrated with the declining function of the board chair and who see no possibility of ascending to the position.

How much time does it REALLY require? Measure and share the time requirements of the board chair role. Knowing the actual range of time it takes to perform the role of board chair is incredibly useful in recruiting candidates for the position. It indicates that the role is clearly defined with specific functions and enables prospective candidates to honestly assess their ability to commit to the job. A defined time parameter, combined with term limits, makes the chair position much less of a “black hole” commitment. Boards should require their chairs to log the time spent on the job by week, month, and year, then monitor the average time spent over the terms of successive chairs. This will both allow an accurate picture of the time demands, as well as allow boards to identify and respond to “upward time creep” where the role of the board chair takes increasing amounts of time. It also enables a more robust evaluation of the performance of the board chair pursuant to term renewal (Is the chair spending significantly more or less time than the average? Is that understandable due to a significant circumstance like the pandemic? And so on). Also, if the trend is that the role is necessarily taking more time, the board can then focus on reframing the job to minimize time demands. Once your board has determined the time requirements of the job, they should be prominently included in the board chair job description.

Reduce the time demands on the board chair role. If the job of the board chair has expanded to the point of being a burden, reframe the job by dividing some of the work among other board leaders including the vice chair or chair elect, the immediate past chair and committee chairs. Next, call out any implicit cultural expectations of the board chair duties and once made, explicitly determine if they are appropriate or can be eliminated or reduced. For example, a common implicit cultural expectation of the board chair is to attend ALL board committee meetings. This grew from the common bylaws provision making the board chair an ex-officio member of all board committees who may attend any board committee meeting. But is there a requirement that the chair MUST attend all committee meetings? If so, why? If there is no specific requirement, why is there the cultural expectation and can it be explicitly modified? What is the expected routine communication between the board chair and CEO? Often, communication frequency and intensity that may have been appropriate in a crisis or special situation become normalized as cultural expectations of the job even though the crisis or special situation has passed.

Assign certain tasks to the Governance Committee. One of the most challenging tasks for any board is to call out and correct the inappropriate behavior of one of its members. Many boards do not address this as a matter of written policy and defined process. Rather, it is left vague, and the default assumption is that it is the board chair who is solely responsible for this unpleasant task. This can be a major reason why board members are dissuaded from considering the job of board chair. To address this, effective boards first develop a written board Code of Conduct that specifically defines unacceptable board member behaviors. Then, the board assigns the primary responsibility of monitoring and responding to potential or actual breaches of the Code of Conduct to the Governance Committee. The board chair may be involved in the process, but it is not the implicit role of the board chair to deal with this challenging issue alone. Further, one of the critical tasks assigned to the Governance Committee should be board leadership succession planning.

Restructure the Board for greater efficiency. Does the board have too many committees? Too many members? Too many meetings? These structural governance inefficiencies not only compromise effective governance, but they also place additional time burdens on the board chair who often must work around these issues to try to make the board work in spite of any structural impediments. Efficient governance structures and processes both make for better governance function and make it much easier for the board chair to do their job with less wasted time. Inefficient governance structure and processes are off-putting to potential board chairs as they create the distinct impression that the board chair has to do all the work to get anything done, and further that it will take a lot of work by the board chair to change things and make them more efficient.

Select the chair-elect one year before they assume office. Doing so enables the chair-elect to “shadow” the board chair for one year. This lets the chair-elect learn the specifics of the role on the job, and gives the board chair the ability to begin to shift some of the workload to the incoming board chair. Knowing this “shadow” year of orientation is a matter of policy makes the role a bit less mysterious to board members, shows them that they will be supported in getting ready and in performing the role, and makes it easier for them to get in the leadership line. Some boards with multi-year terms for the board chair will select the chair-elect at the same time they choose the board chair, and while the chair is performing their role the chair-elect is learning on the job and is performing certain functions to lighten the load of the chair.

Regularly survey board members. As part of the regular board self-evaluation, or as a stand-alone survey, regularly poll all board members to determine their interest in serving as board chair. Further, clarify any concerns they may have about the position and elicit suggestions for improving the effectiveness and efficiency of the role.

A sure sign of board burnout is the inability to find any board member willing to become the next board chair. By identifying concerns of board members about serving as chair and pinpointing some of the reasons that filling the job is difficult, boards can implement specific strategies to help assure an effective board chair secession planning process and facilitate effective chairpersonship. This will make the prospect of serving as board chair less onerous and may even make it fulfilling and sought-after. In turn, it will help minimize burnout in the boardroom.

Jamie Orlikoff (j.orlikoff@att.net) is president of Orlikoff & Associates, a consulting firm specializing in health care governance and leadership. He is the national adviser on governance and leadership to the American Hospital Association. He is the Chair of the Board of the St. Charles Health System in Bend, Ore.

Please note that the views of authors do not always reflect the views of AHA.