BOARD COMPOSITION AND SELECTION

Succession Planning: A Call for Change in Board Recruitment and Leadership Development

Rethinking Board Recruitment

By Karma Bass and Maria Hernandez

The health care industry is navigating unprecedented challenges — rapid technological advances, regulatory complexities, market consolidation, financial pressures and a swiftly evolving landscape accelerated by legislative changes such as the recent One Big Beautiful Bill Act. Hospitals and health systems now face existential threats requiring visionary leadership to ensure organizational resilience and sustained mission fulfillment. It is imperative for hospital and system boards to adapt their recruitment practices and succession planning to respond effectively to these new realities and actively engage in defining the next generation of board members.

Rethinking Board Recruitment

Historically, hospital and health system boards have included traditional community leaders: bankers, attorneys, physicians, and local business people. While these roles have provided valuable oversight, today’s complexities demand broader, more varied competencies and perspectives. Modern boards must consider:

• Health care consumers. They recognize women’s pivotal role as the family’s primary health care decision-maker and understand how younger generations access care differently.
• Insurance and payer experts. As reimbursement models evolve, embedded understanding of insurer perspectives becomes increasingly vital.
• Public and community health specialists. Their expertise leads to better addressing population health, service gaps and social drivers of health.
• Nationally recognized professionals. For some boards, members who are not from the community can offer fresh insights and specialized expertise centered on national trends that impact every region.
• Lived-experience representatives. Including voices from all communities ensures governance reflects true community needs.

Boards embracing these broader perspectives will be better equipped to tackle health care’s evolving landscape.

Creating a Board That Attracts Talent

Recruiting nontraditional board candidates requires reexamining longstanding practices. If you want to attract different board members than you’ve had in the past, you will need to adapt your board’s culture and governance methods. Here are a few areas that boards will need to assess:

• Reconsider meeting logistics. Frequent, lengthy weekday meetings deter younger, employed professionals. Boards should optimize meeting frequency, timing and duration to attract candidates balancing professional and personal responsibilities.
• Streamline committee structures. Reducing the number of required committees or combining overlapping responsibilities alleviates service requirements and accommodates busy members.
• Enhance meeting effectiveness. Prioritize interactive discussions over lengthy presentations. Aim for meetings that engage all members actively in strategic dialogues and decisions.
• Simplify materials. Provide concise, well-organized preparatory packets. Detailed yet succinct materials help busy members prepare effectively without overwhelming them.
• Leverage the committees’ work. Boards can work through several issues at each meeting when committees address basic activities that can be added to the consent agenda.

Adopting Best Practices in Succession Planning

Effective succession planning requires thoughtful, strategic practices to ensure board continuity and alignment with organizational needs. Boards should:

• Use a board member attributes and competencies matrix. Regularly assess current and needed competencies, demographics and lived experiences to reflect organizational and community priorities accurately.
• Implement staggered terms. Maintain a balanced rotation of new and experienced members to support both continuity and fresh perspectives.
• Develop a robust candidate pipeline. Encourage board members to recommend potential successors and proactively invite prospective candidates to shadow meetings or participate in events.
• Conduct searches to anticipate vacancies. Boards can also consider working with search firms to test the landscape of who is available and interested in serving as part of their efforts to update member attributes and competencies available among potential members.

Planning for Board Leadership Roles

While the board chair and vice chair usually hold no special authority, their impact on board culture casts a long shadow. For many boards, the chair can mentor the vice chair to secure continuity of work when they assume the role of chair. A strong relationship between the chair and vice chair can support the continuity of board protocols and sustain the culture of the board. For boards developing new strategies, a shift in leadership style may be important in the coming years given the rapid change taking place within the health care sector. Leadership positions such as board chair and vice chair require targeted succession strategies distinct from general member recruitment:

• Clearly define leadership competencies. Board chairs should possess strong facilitation skills, encourage inclusive discussions and effectively manage a variety of viewpoints.
• Establish transparent board leader selection processes. Clearly outline criteria and processes for selecting board leadership roles. Transparent procedures foster trust, prevent perceptions of insider decision-making, and encourage broader participation.
• Broaden leadership opportunities. Encourage all board members to consider leadership positions. Personal outreach and private conversations can empower newer and younger members to step forward.
• Collaborate strategically with CEOs. Invite the CEO’s input on necessary leadership traits and consider the CEO’s perspective on whom he or she will work with best. This approach balances executive insights with maintaining governance independence.

Welcoming the Change

Embracing new members and evolving board practices is critical to navigating today’s health care environment. New board members will inevitably raise challenging questions about operational practices, patient access or quality outcomes. Forward-thinking boards should expect and welcome this as an opportunity to reassess long standing beliefs about leadership, governance or strategy. Such queries are opportunities for organizational growth and governance enhancement. By welcoming and proactively preparing for such potentially uncomfortable discussions, boards ensure their organizations can successfully meet current and future challenges.

Preparing for the Future

Effective succession planning and board recruitment transcend merely filling vacancies —they position the organization strategically for long-term success. Boards adopting these forward-thinking practices will better handle emerging complexities, sustain resilience and secure organizational viability in an uncertain health care landscape.

As the health care industry continues its transformative journey, governance practices must evolve in parallel. Strategic foresight, proactive recruitment, intentional succession planning and inclusive leadership development become not just advisable but indispensable for sustained organizational success.

Karma Bass (kbass@viahcc.com) is CEO and managing principal of Via Healthcare Consulting, Carlsbad, Calif. Maria Hernandez, Ph.D., (maria@impact4health.com) is president and COO of Impact4Health, Oakland, Calif.

Please note that the views of authors do not always reflect the views of AHA.