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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.

More and more boards are adopting the practice of using competency-based criteria to select governing board members. They identify the subject areas and behavioral qualities needed from trustees and apply them to recruitment, orientation, leadership development, succession planning and periodic evaluation.

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.

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?

Health care is transforming to a value-based model, with the goals of improved care quality, access and outcomes for consumers, at lower costs. The means of achieving these goals is the effective management of health and health care services over the continuum of a population’s care and service needs.

How well boards govern is influenced by a number of factors, among them, the knowledge and skills board members bring to their work.

In pursuit of its longstanding vision of a “society of healthy communities where all individuals reach their highest potential for health,” the American Hospital Association supports hospitals, health systems and related organizations in engaging in strategic initiatives that together create a path toward advancing health in America.

The uncertainty and complexity of today’s rapidly transforming health care environment requires dynamic CEO leadership more than ever. A sound and steady relationship between the board and CEO helps support the CEO during this turbulent time and, in turn, a close and productive partnership between the board and CEO helps ensure the board’s vision and strategic direction are carried out.

Cybersecurity is an important issue for both the public and private sector. At a time when so many of our activities depend on information systems and technology, it is not surprising that, when we think about our organizations’ vulnerabilities, our information infrastructure must be high on the list.

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.

Telehealth connects patients to vital health care services though videoconferencing, remote monitoring, electronic consults and wireless communications.

Organizations pursuing Baldrige recognition must demonstrate how they carry out their governance in eight areas of responsibility.