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Seven techniques can help support and strengthen your board's decision-making processes.

These are exciting and challenging times for board members of not-for-profit health care organizations. The main driver of this state of affairs is a field-wide transformation that promises to result in better quality, higher value, and population health improvement. Most board members see this as a positive move for their organization and community, since their missions often speak to the need to improve the health of the communities they serve.

The following is intended to be an example that boards should adapt to meet their individual needs. Effective governance depends on the right mixture of skills, experience, personal qualities and diversity among the members of the hospital board.

“No battle plan survives the first contact with the enemy,” goes a military saying, expressed in recent years by Colin Powell. The expression is worth remembering as hospitals and health systems embrace bold strategies to participate in the industry-wide economic shift from rewarding volume to holding providers accountable for the value they deliver.

New research on board structures, practices and culture in large nonprofit systems provides insight into how boards and CEOs are addressing the challenges of change — and changing the way they govern in the process. This workbook explores several themes emerging from review of system documents and 71 on-site interviews with CEOs and senior board leaders in 14 of the country’s 15 largest nonprofit health care organizations.

The AHA’s report on Hospitals and Care Systems of the Future is not intended to be one of those think tank documents that’s quickly forgotten when the next hot idea comes along. The report, which the AHA will update periodically to reflect changing conditions, is designed to help leaders engage in active, thoughtful exchanges about their desired delivery system of the future.

Just as the health industry continues to shift care delivery from a volume- to a value-based model, so too must the health care board evolve beyond its traditional fiduciary and core governance responsibilities to encompass a more strategic and global view. The success of this evolving model depends on shared governance—a stronger alignment and engagement among the board, physician leadership and management.

The road to integration of hospitals and physicians has been a rocky one for many health care organizations. Failed attempts to integrate in the 1990s resulted from the realization that operating physician practices was very different from operating hospitals, leaving many health care providers wary of heading down the same road again.

The Hospital System Board of Trustees Quality Committee shall meet quarterly in order to provide: Visibility and focus for the organization’s commitment to the delivery of high quality medical care; Oversight of quality and performance improvement initiatives across the Hospital System.

Most boards and governance experts say boards should be meaningfully involved in shaping and ultimately approving the strategic plan and major decisions—but if they try to develop plans, they’re bordering on management. The tricky part is distinguishing meaningful involvement from development.

Here are 10 steps for optimizing the way a board uses its meeting time.

High-performing boards across the country have made great strides in enhancing their effectiveness and efficiency.

Today’s hospital leaders know their trustees must be more adaptable, connected and knowledgeable about the changing health care landscape than any of their predecessors. But do they believe their volunteer community board is truly capable of stepping up to current field challenges?

Mergers and acquisitions (M&A) are occurring throughout health care, with transactions happening among entities of all provider types and sizes.(According to the latest analysis by Kaufman, Hall & Associates, LLC, 49 transactions were announced in the first half of 2015, up from 43 transactions in the first half of 2014.)

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.

Securing board approval for a major new project can be a long and tricky process when the CEO proposing it isn’t sure which criteria trustees will use, and the board is equally uncertain what the yardsticks ought to be. At Adirondack Medical Center in Saranac Lake, N.Y., President and CEO Chandler Ralph asked her board to write down and agree on project evaluation criteria. In a two-hour workshop, trustees came up with 14 points that they now apply to every decision about whether to implement a new program.

This is a sample committee charter: people and culture committee.

Despite the importance of the role, many boards do not give selection and preparation of the board chair the attention they should. In a recent survey by The Governance Institute, 64% of boards said they had established an explicit process for selection of the board chair but these processes often are little more than a thoughtful conversation among the executive or governance committee about the next chair.

Even before the Enron scandal, which featured directors who didn’t understand the company’s complex financial transactions, and before the Sarbanes‐Oxley Act required publicly owned corporations to disclose whether their boards include directors with financial expertise, it should have been self‐evident that relevant knowledge and experience are prerequisites for effective governance.  

In 2009 the AHA’s Blue Ribbon Panel on Trustee Core Competencies identified two sets of competencies that focused on the knowledge, skills and personal capabilities needed by trustees of hospitals and health systems to govern effectively.