Case Study

Enthusiastically On Board: Essential Elements of a High-performing Board at Yoakum Community Hospital, Yoakum, TX

The Situation

Yoakum Community Hospital serves as a model of positive CEO-board relations, but establishing this level of board engagement did not happen overnight. CEO Karen Barber has led the 23-bed critical access hospital in rural Texas to a status worthy of national recognition, with strategic direction from an engaged, effective board of trustees. Barber says she feels “fortunate” to be backed by a high-performing board, but it was her own efforts along with the trustees’ that put all the elements in place for the exemplary board Yoakum has today.


Before Barber became CEO in 2006, the hospital board was less effective, mainly because trustees didn’t previously receive all the information they needed to make well-informed decisions. Trustees were challenged in performing their basic fiduciary and financial duties because reports provided to them were often incomplete or inaccurate, says board chair and longtime trustee, Elorine Sitka.

Sitka and Barber agree they have a fully engaged, high-performing board, and that’s not just because trustees receive thorough, accurate financials as a matter of course. Sitka, who also previously served on Community Hospital Corporation’s Board of Directors, applies CHC’s recommended board best practices with Yoakum’s board. Barber works closely with CHC on continuously improving board relations and engagement. Their concerted efforts and combined wisdom have made all the difference.

“The Yoakum board members work together and with administrators very well,” says Craig Sims, who serves as CHC’s SVP of Hospital Operations and regularly consults with hospital boards. “When challenges arise, both the board and the CEO know they have the open communication—including the occasional spirited debate—and mutual support they need to find an appropriate resolution.”

The Plan

Acknowledging that no hospital board is perfect, Barber sees to it that certain elements are in place to set the stage for continuous improvement. Those elements include:

  • Clear expectations regarding roles and responsibilities
  • Candid, consistent communications
  • Useful and efficient meetings
  • Thorough on-boarding process and ongoing continuing education
  • Continuous recruitment and retention efforts
Best Practices to Help Build a Better Board
  • Develop a specific recruitment process for new trustees.
  • Develop an orientation and education plan for new trustees, and ask them to evaluate the experience after six months.
  • Create multiple communication touch points (intranet, newsletters, frequent informal communications) with board members.
  • Send out board packets at least one week before meetings.
  • Move informational items off the agenda and focus on three to five action items.
  • Build informal discussion time into board meetings.
  • Conduct annual self-evaluation surveys to identify opportunities for improvement.
Roles and Responsibilities

Blurring the lines between governance and management is one of the biggest potential contributors to board dysfunction. At Yoakum, board members understand and adhere to their role as strategists and overseers, and leave management and operations to Barber.

“We have confidence that Karen will create and implement tactics that support board strategies,” Sitka says. “Once we provide direction, she provides regular updates to keep us in the loop.”

Putting a board’s specific roles and responsibilities in writing helps prevent boundary breaches, and a candid discussion about mutual expectations can bring about even more clarity. What do the trustees expect of the CEO? What does the CEO have the latitude to do without prior board approval?

Open Communication

Barber constantly shares timely and critical information with the board including regular informal phone calls and a weekly newsletter. Through an online portal, she provides board members with meeting materials to review at least a week in advance. Trustees, in turn, are expected to reach out to Barber if they have a question or concern, do their homework, come to meetings prepared, and participate in discussions and respectful debates.

Meetings That Matter

In order to keep meetings moving along, CHC recommends moving informational items off the agenda for trustees to read on their own and focusing face-to-face time on three to five major issues that require voting. As board chair, Sitka makes sure board meetings stick to the agenda.

“It’s almost a joke among the board members how strictly I stick to the agenda and don’t let us stray from the topic at hand,” Sitka explains. “In reality, the other trustees appreciate this because they are all very busy, and we keep meetings short and on point.”

But it’s not all work and no play. Barber believes meetings are so efficient partly because attendees share a meal together beforehand, “so there’s time for socializing and fellowship before getting down to business.”

The Right Recruits

When it comes to recruiting new trustees, conventional wisdom holds that it’s harder for small and rural hospitals to avoid problems like conflicts of interest because they have a smaller pool of potential candidates. That’s one reason why CHC recommends that hospitals develop a specific recruitment process for new trustees.

Both Yoakum’s board members and Barber keep a running list of potential board members and emphasize including successful members with diverse backgrounds. The board sought out recent recruits from neighboring towns in an effort to bring a fresh perspective and open an avenue for physician recruitment and increased market share.

“It’s really important to identify members without a personal agenda.” Barber says. “We all put the needs of the hospital first and work together toward the common goal of improving the hospital for the good of the community.” The Yoakum board also includes one District representative. Through Barber’s leadership, this support from the District has helped the overall flow of communication between all parties.

Education and Other Investments

Orientation of new trustees is vital and should include meetings with key stakeholders including the CEO and CFO, as well as CHC. At Yoakum, orientation includes meetings, a tour and educational materials including an organizational chart and a glossary of healthcare industry terms and acronyms. Board members regularly hear presentations by hospital staff and are encouraged to attend state trustee education programs.

The hospital also invests in an annual board retreat and involves trustees in its monthly birthday celebrations and other hospital events.

The Results

It’s no coincidence that Yoakum’s board and its financial picture improved. It takes a great board to create the environment for management and the hospital to succeed. CHC previously featured Yoakum as a “Rural Model Hospital of Success,“ and Sitka—then a board member—said of the hospital’s turnaround, “You could feel the difference at our board meetings. When I came on the board, things were bleak. Today we have a strong board and dependable, trustworthy leadership all working for a common purpose.”

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