Building Better Hospital Boards
Great community hospital boards generally don’t just come together as if by magic. Rather, they are systematically and strategically built — and, on occasion, boards must be rebuilt.
In today’s tumultuous healthcare environment, hospital boards confront frequent changes and challenges. Subpar board performance can harm a hospital’s finances and reputation, while peak performance promotes quality of care, patient safety, financial stability and community support.
There is no one-size-fits-all approach to hospital board revitalization. However, some longstanding and emerging governance best practices are broadly applicable, and the process often involves putting new people and policies in place to improve board efficacy and cohesion.
Recruiting the Right People and Preparing Them for Success
A high-functioning board, according to Texas Healthcare Trustees, is “knowledgeable,” “collegiate,” “passionate” and “operates with integrity.” Adding to the list, a solid board is also diverse, well-rounded in terms of skill sets, and clear about roles and responsibilities.
In order to check all these boxes, board member recruitment takes a bit more sophistication than asking for nominations from the community. Montrose Regional Health (MRH), a CHC-managed hospital in Montrose, Colo., developed a process for vetting applicants including a preliminary interview aimed at determining, among other things, if they’re fully invested as opposed to looking to enhance their resume.
New board members complete a structured orientation program to familiarize them with the hospital’s mission and objectives; the board’s role and responsibilities; the expectations of board members individually and as a group; and the strategic vision of where the hospital is going. Orientation includes meetings with key stakeholders, including the CEO and CFO, and provides new board members with resources including the board’s bylaws and policy manual, and a glossary of healthcare terms and acronyms.
Traditionally, hospital boards have been composed of community and business leaders skilled in finance, investment, fundraising, marketing and other key areas. Going forward, board members with clinical backgrounds, healthcare management experience, human resources, and information technology acumen will be highly sought-after, as well. Ideally, boards are diverse in terms of race, ethnicity, age and gender to better represent and serve the community.
Implementing the Right Policies and Procedures to Optimize Efficiency
High-performing hospital boards often have continuing education requirements so board members stay up to date on changes and emerging challenges in the healthcare industry. In addition, some hospital boards are enforcing attendance policies to ensure all members are committed, informed and contributing.
Like many hospital boards, MRH experienced a challenge keeping meetings on track. Toward this goal, the board now sets aside time for informal discussion among board members before the CEO and other attendees join. The time is limited but worthwhile, as it improves focus and efficiency and prevents board members from straying off-topic in open meetings.
Other practices that keep proceedings on track include sending out board packets at least one week before meetings; moving information items off the agenda for board members to read on their own; and focusing face-to-face time on three to five major issues that require voting.
An effective hospital board strives for continuous improvement, building on formal self-evaluations conducted at least every two or three years. The board should also evaluate its chair six months to a year before term expiration so the board has time to find a successor in the event the board chair position is vacated. Board self-assessments identify opportunities for improvement and provide the basis for reappointment decisions.
Focusing on the Right Priorities to Ensure Sustainability
Too often, community hospital board members blur the lines between governance, management and operations. It’s important to keep the board focused on developing effective strategies and let hospital leadership handle the execution. Board responsibilities include providing guidance in these six key areas:
- Strategic direction
- Financial performance
- Quality care
- Executive performance
- Stakeholder relations
- Board structure and performance
Posting clearly defined job roles and requirements when recruiting new board members can help eliminate organizational dysfunction. Formal job descriptions for board members, board chairs and committee chairs also keep incumbents focused on their governance functions.
Having raised the bar for hospital board performance, MRH sought advisory assistance to give board members a boost. Hospital board advisory services, such as those offered by CHC, help board members navigate changing regulations, manage challenging market conditions, and optimize hospital performance. Many hospitals that set out to build a better board find that advisory services provide them with a foundation and blueprint.