Category: Leadership

Mission Focused Board Leadership


Most board chairs and their board members face extremely complex healthcare issues, as well as higher performance expectations in their roles. Collaborating on changes in medical services arrangements is expected, growing market share is a necessity, financing is crucial and ensuring community critical services access is a must. The importance of boards putting their community health first and being mission-focused in moving from volume-to-value-based care has become the basic white waters that boards must navigate.

In most cases, boards have stepped up their game in response to the multitude of challenges confronting their organization. However, most also agree their governance culture and practices still need improvement if they’re going to be a valuable partner in leading their organization through the transformational changes they face.

Where to Begin

Every board annually needs to critically assess, evaluate and determine its strengths and weaknesses in relationship to what it will take to lead their organization. Unfortunately, most boards are not used to having these types of introspective conversations with themselves.

Critical to governance success is conducting annual board self-assessments via facilitated retreats. These events should focus on board performance, action plans for improvement, and establishing educational programs.

Wherever boards are on their journey to better governance there’s no doubt that effective governance begins and ends with their CEO and how he or she views their boards relationship, which can range from nuisance to threat to thought leadership and anywhere in between.

Without CEO support, any board will have a difficult time partnering in leadership because any board action can be snubbed by the CEO as micromanaging or overstepping into management’s domain.

After the CEO, the board chair is the most influential person shaping the board’s effectiveness. It is extremely difficult, if not impossible, to overcome the problems of a weak or overly controlling leadership on the part of the chair.

Keys to Success

A shared balance of organizational power between the Board Chair and the CEO is critical to the success of their partnership.

Managing egos is critical for good governance. When one or both has a big ego, things get out of hand in a hurry in the boardroom.

According to Demb and Neubauer (1992), the following factors build trust between a Board Chair  and CEO team:

  • Personality, chemistry and style of the CEO.
  • Having a climate of openness, clear and consistent communications.
  • Adherence to well-defined roles and agreed on performance expectations between the Board Chair and CEO and vice-versa.
  • Collaborating the right issues in the right way at the right time.
  • Ensure that nothing is undiscussable in the boardroom.

Characteristics of an Effective Board Chair

  • Effective communicator, consensus builder, respectable in conflict management and encourages dialogue and participation from all board members.
  • Governance work gets done at meetings. How well the meetings are planned and conducted has a huge impact on a board’s performance and achievement.
  • The most important determinants of board meeting effectiveness and efficiency is the chair’s knowledge/skills in the areas of agenda planning and meeting process facilitation.
  • Ensuring everyone has an opportunity to weigh in and no one dominates or bullies is critical for sound decision making.
  • The most effective chairs are characterized by vigorous discussion, deliberation and debate; encouraged by engaged, active, thoughtful and prepared participation.

Governance Committee

The caliber of the board chair enormously influences the quality of governance. It’s not uncommon for non-profit boards members to be unclear about how a board chair is selected.

The selection process many times is either informal or improvised.

The effectiveness of the organization governance depends on the conscientious nomination process for both board members and the chairperson. It must be transparent, understood and inclusive.

The governance committee should poll their board for their thoughts and recommendations:

  1. Determine and validate the do-ability of the chair’s roles and responsibilities to the board and to senior management [bylaws are usually vague],
  2. Set 24-month goal and objectives for the next chair,
  3. Determine the desired attributes, personality traits, skills and experience that are essential and
  4. Take to and discuss with the full board and CEO for their approval.

Chairing a non-profit healthcare organization board demands a huge commitment of time and effort. The opportunity to exercise leadership in one of the community’s most important institutions is priceless.

How Do Board Members Get to Know Their Medical Staff?

QUESTION: “How do board members get to know their medical staff providers without being perceived as micromanaging or going around management’s back?” This is a question often asked by board members who admittedly say they do not know their medical staff or how to approach them.

A board member shared with me that when she speaks with physicians, it often gets back to hospital administration and is perceived as going around management.

She was lost as to what she should do.

Business is all about relationships, but what if you are not in a relationship with your “rainmakers”?

When presenting on the topic, “How to Improve Hospital – Physician Relationships” at regional board of trustees conferences across the country, I always ask for a show of hands on the question, “How many of your physicians are associated with your healthcare facility because of their relationship with the board of trustees?” At four conferences, with 100 plus attendees at each, I counted only two raised hands.

When the following question was asked at the same regional conferences “…in relationship to the chief executive officers and their executive teams,” only one show of hands was noticed.

And when this question was asked “…in relationship to the nursing staffs” there was no show of hands.

In addition, when I asked, How many trustees had a board-driven policy declaring how they wanted their organizations to deal with their physicians?” – I had no show of hands.

Relationship Consequences

If key physician relationships are strained, fractured, deteriorating or plainly written off, you can clearly understand the reasons why. It may also be why the culture and values in healthcare relationships are deeply rooted with miscommunications and mistrust.

If the truth were known, many boards of trustees would not be comfortable dealing with physicians; hence, they avoid the encounter. While some boards may be at ease speaking with the few physicians they know, other physicians often perceive this contact as favoritism.

Likewise, many physicians do not know who is on the board of trustees of their healthcare organization. In addition and above all, many physicians do not know what board members responsibilities are.

If boards of trustees have not discussed and come to consensus regarding a policy on how they want the organization to deal with their physicians, they can easily be perceived as micro managers or bypassing management when they seek out physicians.

Rethinking Working Relationships

The relationship of the board of trustees with their physicians must be rethought and new strategies developed on how they want their organization to deal with their primary rainmakers.

Discussing and arriving at consensus on the following questions is essential:

  1. Should the board of trustees establish a relationship with their medical staff?
  2. If the answer is no, you need to understand why. And if the reason is “because that is why we have management” then you need to have a deep discussion about being accountable.
  3. If the answer is yes, then you need to discuss what those relationship will look like and develop a policy to improve the relationships with their medical staff providers to whom they have delegated patient quality assurance.

A facilitated board retreat with full discussion should center on:

  1. Identifying current perceptions that each:
    • board member has of his or her current relationship with the medical staff Providers.
    • medical staff Provider has of his or her current relationship with the board of trustees.
  2. What work relationship expectations does the
    • board need from their medical staff providers?
    • medical staff providers need from their board?

Creating New Relationship Expectations

Developing an explicit written “hospital – physician relationship policy,” describing the working relationship expectations each has of the other will certainly improve individual accountability, communications and trust.

A particular board of trustees, after full discussion amongst themselves, engaged the hospital’s executive team and their medical staff leadership to come up with the following action plans to establish their first ever “hospital – physician relationship policy.

  1. The board of trustees executive committee, chief executive officer integrates itself with the medical executive committee to establish a joint conference committee which meets monthly.
  2. The board chair, chief of staff and chief executive officer meet weekly to discuss strategies and operational issues.
  3. The board of trustees encourages the development of a medical staff leadership council, which is responsible for not only recommending clinical operations improvements, but also defining and prioritizing broad-base physician needs, and for upward and downward communications to and from the medical executive committee, hospital management and board of trustees.
  4. The new physician orientation and onboarding process includes attending and being introduced by the chief of staff at the board of trustees meeting.
  5. The board and hospital management have two major social functions a year for the full medical staff members and their significant others.
  6. Annually board of trustees will bring their medical staff leadership  together to assess their current relationships and develop the necessary action plans for improving their relationships.

Engaged Physicians: Critical Success Factor

Investing in physician engagement by institutionalizing a collaborative Hospital / Physician Relationship Policy that demonstrates between and among Board Members,  CEO, Employed and Independent Medical Providers:

  • Basic respect and inclusion
  • Functional working relationships
  • Communications protocols
  • Being responsive and receptive to providing high quality care for their patients

Is Healthcare Leadership a Victim of its Culture?

Lethargic Cultures

The culture of healthcare organizations continuous to be in a vicious cycle of self-perpetuation in an organizational climate of mistrust, miscommunications, finger pointing, discrediting and hoarding of control.

Dysfunctional behaviors are condoned and rewarded every day by performance reviews not given, salary increases, budget appropriations and contract approvals. Healthcare culture appear to be in a survival state of defensiveness, physical slowness and mental dullness.

Where is Healthcare Leadership?

Why is it so hard to see and feel the confidence and courage in the board of trustees, hospital management and medical staff leadership who everyday, whether they realize it or not, by their daily actions, create or reinforce the culture within their organization?

The board of trustees must step up and become accountable for setting in motion a  process for renewing their organizational current culture by re-aligning key stakeholders’ roles, expectations and behaviors for themselves, hospital management and medical staff leadership.

Most boards do not know they are accountable for their organization’s culture, they rely on their CEO for recommendations and continue operating in a traditional hospital governance model – which in most cases is the status quo.

Board members, CEO, Senior Leaders and Medical Staff Providers need to examine together real experiences that constitutes their current attitudes and behaviors when they interact with each other. Determining functional relationships is about being in sync and aligned with clear roles and agreed on expectations.

Going Forward

The board of trustees are responsible for discussing the following:

  1. Institutionalizing a collaborative management philosophy and style that incorporates and demonstrates organizational values of being:
    • Accountable for one’s actions through timely execution and follow through of their duties.
    • Open to change and part of the solution.
    • Timely with all communications
    • Responsive and receptive to providing collaborative quality care for their patients.
  2. Improving communications and one-to-one working relationships between and among Board Members, CEO, Senior Leaders, Employed and Independent Medical Providers and Clinical Caregivers specifically:
    • Basic respect and well mannered personal interaction styles.
    • Communications protocols: to, from, up and down.
    • Unified team environment with functional working relationships.
    • Key stakeholders who understand and accept their distinct accountabilities for the success of their organization.
  3. Some Board’s engage a third party facilitator who is experienced in conducting relationship assessment to assist them ascertain what it will take to improve one-to-one key stakeholders’ relationships, communications and to determine if their current culture [the way they currently think and act], can produce the going forward organizational results needed? If it can’t… what needs to shift to achieve the desired end results needed.
  4. Providing the relationship assessment feedback and recommendations to the board of trustees, hospital senior management and medical staff leadership characterizing their current culture.
    • Behaviors and beliefs
    • Interacting tendencies
    • Areas of strength
    • Areas needing performance improvement
    • Areas of conflict and tension
  5. Then, facilitating a multi disciplined collaborative plan of actions with accountabilities and timetables for the board of trustees, the hospital’s senior management and medical staff leadership to renew and align their relationships to achieve the desired organizational resulted needed.

First and foremost the board of trustees must require accountability of itself, hospital senior management and medical staff leadership. In doing so, working together as business partners modeling direct, honest and open communications, establishes the beginning of new rules of engagement, which starts with individual accountability, which shifts the organization to the desired culture.

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