Governance Collaborative: Next-Generation Board Development

By Mary K. Totten

It would be hard to disagree with the notion that board development is essential to effective trusteeship. Anyone who has sat on the board of a hospital or health system knows that health care is recognized as one of the most complex sectors. Even if board members are not new to governance, it takes many hospital trustees at least a year to get up-to-speed on the issues and trends in the field so they are comfortable participating regularly at board and committee meetings. It’s even likely that the well-worn rule-of-thumb that health care organization board service requires three years to learn, three more years to do and three more years to lead is probably still not too far off the mark. That’s because not only is the field itself transforming and local markets regrouping to deal with out-sized change, but a growing number of hospitals now belong to systems (about 66 percent, according to 2016 survey data from the American Hospital Association). Board members not only need to learn about the organization they directly govern, but also how that organization and their board fits into the larger health care systems of which they are a part.

A complex field in which organizations are experiencing rapid, ongoing change requires that boards have a strong development component built into their governance practices. A solid orientation, regular board education and meaningful board performance evaluation are foundational elements for basic board competence. While survey data suggest that a majority of health care boards have adopted these practices (2014 National Health Care Governance Survey, American Hospital Association), peeling the onion on how individual boards conduct them sometimes reveals lack of consistent, integrated approaches and failure to tie education to actual board work. It stands to reason that these problems are more likely to exist in developing health systems where disparate hospitals and other organizations have come together but may not all approach governance in the same way. For some hospitals, the traditional half-day orientation session at the hospital and attendance every year or two at an outside education program are goals they still aspire to achieve.

To