Resource Library

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.

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.

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.

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.

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.

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.

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

As community leaders, trustees are a powerful voice for their hospitals or health systems when it comes to advocacy. They can offer legislators “real life” insights and perspectives into the challenges facing patients and community members in the hospital’s service area, as well as how legislation and regulation will affect the women and men who work every day to fulfill their hospitals promise of help, hope and healing.

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.

Analytics can be a tool for constructively engaging physicians in health systems’ transition to value