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Board Composition and selectionGetting Nurses on Board(s)Why health care organizations should consider adding nurses to their boardsBy Kimberly Cleveland, Pam Rudisill, Anthony Vander Horst and Laurie BensonIn 2021, the National Academies of Science, Engineering, and Medicine released

Board Composition and Selection How to Navigate Complex, Multitiered Governance Success comes from defining expectations for various stakeholders By Linda Summers, Erica M. Osborne and Karma H.

Adding diverse members to a hospital’s or health system’s board can change the board’s culture for the better.

An emerging group of future health care leaders are ready to take on the challenge of health care board service.

Is granting an outgoing trustee ‘emeritus status’ a thing of the past?

Millennials use the health care system in a unique way. Trustees must be attentive to their views and recruit them to the board for its long-term sustainability.

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.

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.

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.  

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.

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.

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.

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.

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. As their organizations mature, effective boards update how their members are selected, often moving away from informal, relationship based board composition to a more intentional, competency-based process.

In many ways, women are on the front line in health care — as consumers, employees and family caretakers. They possess firsthand knowledge of community health issues and needs. They can bring an informed perspective to health care and other community organizations about where to focus resources to have the greatest impact.

A decade ago, BoardSource, an organization supporting nonprofit boards, developed a well known list of aspirational principles of governance. For us they still ring true: “mission driven,” “ethos of transparency,” “compliance with integrity.”

Most boards I know were built by recruiting business leaders, physicians and clergy, and it’s important to have broad community representation among trustees. Increasingly, however, boards are recruiting new members by using a skills-based approach aligned with the organization’s strategic needs, including the need for information technology expertise. This is where “digital directors” come in.

In July 2011, five national health associations jointly urged hospital and health system leaders to take three steps to help eliminate health disparities and improve quality of care. These steps called for increasing...

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.