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The highest-performing boards across the country share certain key characteristics that can be grouped into five categories - visionary, nimble, intentional, competency-based and objective.

The AHA’s 2017 report documents how leading health care organizations and their boards, in collaboration with other community partners, are beginning to expand efforts to addressthe myriad of social determinants that significantly affect the health of their communities.

The Triple Aim of improving the experience of care, improving the health of populationsand reducing per capita costs of health care is a nationally recognized goal that provides context for much of the work now underway to redesign existing systems for care, payment and collaboration to achieve better health outcomes for all Americans.

Guided by their organization’s mission, vision and values, trustees must govern with their eye on the future, the well-being of patients, and the health of their communities.

By Mary K. Totten and Pamela R. Knecht In today’s health care environment, the need for collaboration has perhaps never been stronger, with hospitals and health systems pursuing partnerships in a number of ways, including alliances, networks, affiliations and, at times, full mergers and acquisitions. In both the for-profit and nonprofit sectors, one form of collaboration — joint ventures — has long been viewed as a sound strategy for achieving multiple objectives.

Traditional community-based boards in health systems and hospitals have long been the stalwart of health care governance because of their value in connecting health care organizations to the communities they serve.

This year’s Thought Leader Forum was an opportunity to engage in executive dialogue around the topic of change leadership with a panel of top executives whose organizations have recently undergone significant changes, such as care model transformation, unconventional affiliations, large-scale acquisition, new service strategy, and infrastructure or organizational changes. We will discuss how they executed and managed change; key lessons learned; and how culture, engagement, brand, and systems factored into the changes.

For boards to participate in shaping their new organization, they must be currently performing at an extremely high level. The following is a list of four practices that hospital and health system boards must be engaged in today, in order to be successful in the future.

The traditional acute-care hospital is becoming just one of the entities within a larger system that probably includes primary and specialty care clinics, ambulatory care sites, behavioral health care and post-acute care. In addition, the systems may be employing physicians, developing robust philanthropic organizations, developing entrepreneurial businesses, conducting research and offering medical education.

Society and industries are always evolving; revolutionary change occurs sporadically when powerful forces align to disrupt the old order. The health care delivery system today is in the midst of an historic transformation to redesign how care is delivered. The quite immodest aim is to take 20 to 30 percent of costs out of the system while maintaining or improving clinical outcomes and patients’ health.

A 2012 study of Governance Practices in an Era of Health Care Transformation conducted by AHA’s Center for Healthcare Governance found that work to create greater value is where hospitals and systems in the study— and their governing boards—are spending most of their time. According to study findings, participating organizations “are concentrating on the nuts and bolts of… reducing costs and improving care quality.” The work is wide-ranging and intensive:

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.

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?