Trustee Toolkit

To expedite the conduct of routine business during board meetings in order to allocate more meeting time to education and discussion of substantive issues.

A duty of obedience to the charitable purpose of the organization, a duty that should be demonstrable in all the board’s decisions. A duty of loyalty, to act based on best interests of the organization and the wider community it serves, not the narrow interests of an individual or stakeholder group. A duty of care, to be diligent in carrying out the work of the board by preparing for meetings, attending faithfully, participating in discussions, asking questions, making sound and independent business judgments, and seeking independent opinions when necessary.

To clarify the difference between the board’s policy making responsibilities and management’s operational responsibilities.

The dashboard or “balanced scorecard” has become a staple of effective governance. Charts and numerical data provide a comprehensive picture of organizational performance. Here are some questions to assess whether your board’s dashboard is as good as it could be.

Leadership. Guides and directs the governance process, centering the work of the board on the organization’s mission, vision and strategic direction.

Overall Roles and Responsibilities -The Governance Committee provides for the board’s effectiveness and continuing development.

The Quality Committee assists the board in overseeing and ensuring the quality of clinical care, patient safety, and customer service provided throughout the organization.

A Board Orientation Manual reinforces information provided during orientation seminars. Consider these items in custom-designing an orientation manual for your board.

An increasing number of boards are moving away from having a standing committee on strategic planning. They reason that the entire board should understand and have a role in major decisions about the organization’s strategic direction, programs and services.

All new board members should participate in an orientation process shortly after election to the board. To design your board’s orientation process, consider these best practices.

CEO goal-setting and evaluation is a fundamental responsibility of a governing board. These questions are designed to help boards assess their CEO evaluation process and determine if any improvements are necessary.

The following is intended to be an example that boards should adapt to meet their individual needs. This self-assessment tool will provide you an opportunity to evaluate our committee’s performance and contributions.

Be sure every member fully understands his or her accountability, responsibilities and the expectations of the office, and document it all in a written position description...

Regular board self-evaluation is integral to effective governance. Use the questions in the attachment to assess whether your board is getting maximum mileage from its self-evaluation process.

The American Hospital Association’s report, Hospitals and Care System of the Future, describes a series of “must do” strategies and future core competencies hospitals will need as they transform themselves from first curve to second curve delivery systems, driven by a shift from volume-driven to value-driven payment systems.

Governance responsibilities today are so significant that board members must bring more than commitment to the mission and interest in serving. As William Bowen writes, every trustee should bring a “specific competence or experience needed on the board.” This sample provides a board policy statement on competency-based recruitment, election and re-election of board members. Use it to customize a process for your board.

AHA’s Center for Healthcare Governance would like to thank Sierra Vista Regional Health Center and its Board of Trustees for sharing this sample mentoring feedback form.

See attached sample strategic planning policy.

The American Hospital Association’s report, Hospitals and Care System of the Future, describes the transformation of health care delivery from first curve to second curve, driven by a shift from volume driven to value-driven payment systems. While there is no single “end state” model that suitable for all organizations or communities, the report offers a compelling vision of “care systems” that are accountable, integrated and coordinated around patient and community needs.”

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. Agendas should reflect the most important strategic issues and priorities, and make efficient use of trustees’ valuable and limited time; meetings should be designed to maximize trustees’ ability to engage in critical dialogue; and committees and task forces should be used to enable the board to focus time on high-level strategic discussion.