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Recruiting board members is a challenge for every hospital and health system, but the task is particularly difficult in small communities. At Benefits Health System, Great Falls, Mont., our pool of candidates is largely limited to the city’s 60,000 residents, despite the fact that we are the tertiary referral center for a population of 250,000 across nearly 40,000 square miles of rural Montana.

With health reform comes increased demand for transparency about organizational performance and accountability. While most hospital and health system senior leaders realize this, board members, surprisingly, may not. As such, boards must have a clear understanding of their accountability to the organization’s stakeholders in order to govern effectively.

The evolving U.S. health care system will demand more standardization, reduced variation in outcomes and lower costs, necessitating new care delivery methods. A variety of models may emerge but physicians are the one constant to any emerging care paradigm, making hospital physician alignment imperative.

This Mind Map, developed in association with innovation partner HDR, depicts a variety of business objectives in healthcare today that are top of mind for healthcare strategists.

The U.S. health care system is quickly moving toward a care delivery model that encompasses entire populations, not just the patients who present themselves for care. This is because many at-risk individuals in the community seldom, if ever, seek treatment or health screenings—and they have a disproportionate impact on total health care spending.

This 2014 National Health Care Governance Survey includes many questions from previous surveys that allow insightful comparisons of governance evolution over time. It also probes new areas to enable a better understanding about how hospital and health system boards are preparing for and responding to the transforming health care environment.

Information technology can be the catalyst in transforming the health care delivery system.

Is participation in a super clinically integrated network (CIN) in your organization’s future? Here are some questions for health care organization boards and leadership to consider.

Serving on the boards of a hospital system and its health plan offers a unique governance perspective. My journey as a student of governance began 10 years ago when I attended a course on board best practices. As president of the Health Plan Alliance in Irving, Texas, I thought this would be a good way to enhance my communication with my own board, which is made up of C-level health plan executives.

The emerging health care environment has changed the game for health care organizations and for physician leadership. The turbulence of that environment is going to require what could be called “agile organizations” adept at matching leadership and decision-making styles and setting and executing strategies appropriate to the nature and depth of environmental change.

Health care governing board members confront a complex and changing financial landscape in their role as stewards of health care organizations. Hospitals and health systems have faced slim bottom lines for an extended period that have reduced available dollars to invest in organizational advancement and forced many to change strategy, forego acquisition of new technology, delay physical plant improvements, reduce services and streamline staff.

Succeeding in the care coordination environment means leaving behind the hospital business model.

Great health care boards primarily focus on enabling their organizations to create innovative solutions that address community needs for improved health and well-being. They also address regulatory, competitive, resource and other challenges that sometimes may seem daunting, but these do not divert them from their primary purpose.

The complexity around physician compensation demands defined, layered board oversight.

This article outlines agenda items for the board’s Executive Compensation Committee. It is the first of several that will further explore many of the agenda items discussed below.

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:

Mentoring, a process that pairs board members who are new to their roles with more seasoned board and executive resources for growth and development, traditionally has been used by health care boards to orient new trustees for board service.

As hospitals buy physician practices, board compensation oversight must shift into high gear.

Don’t overlook the importance of CEO-board etiquette — it’s a pillar of good governance. 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.

Given the sweeping changes in health care, forward-thinking hospitals, systems and medical centers are carefully evaluating board member succession and recruitment. The challenging environment in which these organizations operate requires strong, knowledgeable boards whose members have deep insights into the field and a fundamental understanding of business, management practices and how to compete in a highly competitive market.