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Board chairs are often chosen based on peer respect, professional knowledge, demonstrated commitment such as chairing a board committee, and willingness to put in the time required. A somewhat surprising finding to emerge from the AHA’s 2011 Governance Survey is that conflict management is an important yet seldom discussed role of the board chair.

Over the last decade, and especially since the Enron failure, boards of all types have been working to enhance their performance. They ensure their composition is competency-based; they align their structures with their strategies; and they have robust, written governance procedures.

Health systems and hospitals are becoming increasingly complex, expanding beyond the traditional hospital/parent company model to include new structures and strategic partnerships to support a wide range of care for patients in their communities.

Here are some of the questions that we as governance consultants hear most frequently about board committees.

In most professions, there are clear and relatively consistent pathways along one’s career continuum, as well as clearly defined experiential and educational requirements. Not so with health care governance staffing, which ranges from board support provided by a CEO’s assistant all the way to a comprehensive governance support staff led by a senior vice president/chief governance officer.

A board member/trustee with a nursing background brings a unique voice to governance conversations focused on the Triple Aim. Nurses bring expertise in and valuable perspectives about community health, quality, safety, patient experience, workforce development, staff engagement and financial stewardship.

Whether a board’s starting point is average performance or mediocrity, the journey to the top echelon of governance effectiveness cannot be achieved with a few quick steps. Board development is more like a marathon than a sprint.

Several events can lead to a decision to down-size a board. In some cases, the trigger is a merger or an acquisition in which seating all legacy directors would result in a large, unwieldy board or produce an imbalance favoring one of the combining parties. In other cases, a large board simply decides its present size is an impediment to efficient and effective governance.

With the recent rounds of health insurance company merger and acquisition activity, many hospital executives and their boards may be wondering if a provider-owned plan might make sense for them.

Recently, I sat in a board meeting of a leading U.S. health system as trustees were discussing their strategic vision for the system, and how the rapidly changing health care field, marketplace and regulations were having a profound impact on its future.

For a hospital board to be effective, it must first be engaged. Specifically, board members must actively and productively participate in the work of governing. This is absolutely vital in today’s health care environment, which is full of volatility, uncertainty, complexity and ambiguity.

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.

The tools that follow lay out a framework to assist you in that thinking and planning process with a focus on the competencies of individual trustees.

As the drumbeat of attention to governance effectiveness intensifies, the evaluation of individual directors is off-limits no more. Indeed, the New York Stock Exchange, Business Roundtable and National Association of Corporate Directors all recommend that corporate boards institute individual director assessment.

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.

Boards that want to improve their approach to conflicts of interest and independence management do the following...

Health care CEOs may need a little help. How about hiring a chief of staff?

Carolinas HealthCare System’s Journey to Revamp Its Mission & Vision Statements to Better Represent the Heart of the Organization

An aging population, increasing rates of chronic disease and the onset of value-based payment structures are among the many drivers that have moved hospitals and health systems in recent years to take a more prominent role in disease prevention, health promotion, and other public health initiatives.

As health care organizations become more complex and diverse, their governance requires individuals with a range of knowledge, skills and behaviors that can address the needs and challenges of these evolving enterprises. As their organizations mature, effective boards update how their members are selected, often moving away from informal, relationship based board composition to a more intentional, competency-based process.