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The AHA’s 2011 Governance Survey shows that good governance practices continue to take hold among hospitals and health systems. Driven by powerful economic pressures and stringent legal requirements to be visionary, strategic, diligent and independent, boards are applying various “good governance” practices, including competency-based succession planning, board orientation and education, routine executive sessions, CEO retention planning, and board self-evaluation.

As boards navigate between today’s fragmented, volume-focused health care system and a system that is more integrated and value-driven, there are plenty of issues that keep trustees up at night (see Figure 1). Are the transformational changes now confronting health care organizations affecting the way boards govern?

Given the nature and challenges of small, elected boards, choosing to look inward and improve governance is no easy decision.

Bringing new members onto the board has its challenges. In small or rural communities, the pool of potential trustees is often limited, with desirable candidates already serving on multiple boards. Even in bigger urban areas, it sometimes seems the same people rotate on and off the boards of larger community organizations — the Rotary Club, the chamber of commerce, the hospital.

A reason for being. An organization’s purpose or identity. An expression of what an organization believes it must be to best meet the needs of its stakeholders. These are descriptions of what we commonly think of as “mission.” Members of a health care organization’s board are responsible for governing in ways that help fulfill their organization’s mission. But what does that really mean? How does a hospital’s mission relate to effective governance?

Now that the Affordable Care Act has been upheld, it appears that the American health care delivery system is about to embark on unprecedented change. This transition encompasses a staggering number of issues: integration and physician alignment; significant reduction in Medicare reimbursement; heightened emphasis on quality and safety; the need to evaluate and pursue partnership options, such as mergers and affiliations with health care providers along the continuum of care; defining and delivering accountable care; and ultimately the complete transformation of an acute care based system to systems of care that promote and encourage population health.

The relationship between boards and chief executive officers can be fraught with challenges, and trustees often are unsure of how to handle certain delicate situations. But using a framework of etiquette can provide guidance.

In the publication, authors Joshi and Horak state that hospital trustees support hospitals’ fundamental missions to improve the health of the community. In a climate of growing concerns about the quality of health care and the amount we pay for it, trustees are called upon to oversee the transformation of the culture of the organization.

The rules of engagement for board members have changed dramatically. Historically, the trustee position was honorary; today, trustees are expected to interact more with management and the community and know more about operations.They also have added accountability for legal and regulatory matters. As this role grows in complexity, hospitals are challenged to prepare and educate board members efficiently to be effective fiduciaries without overwhelming them.

Maintaining the public trust a hospital and its board can only be effective if they maintain the trust of those the organization serves. According to the Center for Healthcare Governance and the Health Research & Educational Trust’s Blue Ribbon Panel on health care governance, maintaining the public trust is the board’s most important responsibility."

Health care organization trusteeship is getting more complicated and challenging as pressures to improve quality and safety, reduce costs, increase transparency and accountability, and use changing and evermore-expensive technology converge. At the same time, hospitals face increasing competition from unexpected sources for patients and for professionals in critical disciplines.

Learn about the role of the Chief Governance Officer in hospital trustee boards and how effective governance is crucial in ensuring quality processes and patient safety.

From accountable care organizations to clinical integration, forging a close bond between physicians and hospitals for improved quality results is now an imperative.

There’s hardly a health care board member, past or present, who hasn’t heard of the age-old governance mantra “no margin, no mission.” For years this simple phrase captured what most trustees came to believe was their primary obligation: to ensure the financial viability of their hospital or health system. Days cash on hand, debt coverage ratio and net operating margin were key measures that defined high or low performance.

The hospital's board chair picks up the phone in his office at TriState Bank headquarters. The CEO’s voice on the other end of the line is stark and serious. “The medical executive committee just gave me a unanimous no confidence vote,” he says. “They’re complaining about closed communications and aloofness. And the Gazette called and wants to talk about my compensation."

The role of a health care organization trustee gets 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 evermore expensive technology.

Hospital and health system boards are being overwhelmed by hundreds of quality indicators from numerous sources. Many are required or linked to payment incentives, but some are part of voluntary improvement programs. Amidst the deluge of numbers, leaders could miss valuable, potentially actionable information.

Over the past decade, we have learned much about board effectiveness. A growing body of research has systematically confirmed the intuitive link between board and organizational performance: higher-performing boards are associated with higher-performing organizations.

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.

A board committed to continuous improvement realizes that the value of assessing its performance goes beyond meeting Joint Commission or other external requirements. It knows that regular self-evaluation gives it the information needed to understand and build on its strengths and identify and minimize its weaknesses.