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As health care field changes become more complex, savvy board and executive leaders are intentionally increasing the time that their boards spend in robust discussions of strategic challenges and opportunities.

Because of this generation’s size and increasing influence, Millennials are being surveyed and studied to better understand what makes them tick and how they may play a role in fundamentally reshaping how we live, work—and govern—our organizations.

While most organizations conduct annual board self-assessments, it seems that few boards actually use the results of those assessments to develop specific plans for improvement. According to PriceWaterhouseCooper’s 2017 Annual Corporate Directors Survey, board members’ dissatisfaction with their fellow trustees has reached an all-time high.

As strategic planning becomes a more intense focus for hospital boards, lessons from publicly traded companies may be instructive.

Every day, health systems, hospitals and post-acute care (PAC) providers – such as longterm care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies – confront the daunting task of complying with a growing number of federal regulations.

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.

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.

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.

While most health care governing boards may still rely on paper packets and board agenda books for board and committee meetings, adoption of board portals— Web-based, online workspaces that support health care governance—appears to be catching up with use in other sectors.

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.

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.