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:
Characteristics of an Effective Board Chair
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:
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.
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.
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.
The board of trustees are responsible for discussing the following:
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.
Reality check – If health care organizations are going to succeed in their current environment it will require board members and their CEOs to reassess their understanding of the board’s accountability to its community; its governance model; its strategic plan; its responsibilities for clinical quality; patient safety, finances, patient, physician and employee satisfaction and its ability to assess the recommendations and performance of executive management.
Never before has there been more of an emphasis placed on Trustees leadership skills, business acumen, risk management, collaboration, diplomacy and the ability to think and act proactively.
Health care organizations are staggering from regulations to reimbursement, medical treatment advances to an aging population.
How should boards approach their responsibilities today with the relentless fast moving stream of changes?
How do you find out if their board and its members are being held accountable for their role responsibilities?
Best practice strongly suggests annually conducting an Individual Board Member Performance Self-Assessment.
It is essential for the board to take a timeout each year to think about and rate their own performance. This self assessment is not about the performance of the CEO or the management team. The purpose is to evaluate the board’s satisfaction with aspects of its performance and to be candid on the areas needing improvement.
The objectives are twofold:
Self Assessment questions range from 15 – 20 questions with a rating scale #1 Disagree, #5 agree #10 strongly agree. Each question includes, “How can we improve?”
Each trustee independently and anonymously rates the board’s performance on the set of questions, i.e., “Our board has developed trustee performance expectations that are shared with new candidates and used annually as part of the ongoing performance assessment and reappointment.”
Effective boards take the time and expend the effort to ensure each trustee has a clear understanding of their role and responsibilities and understands the performance expectation the board has of them. Having informed, engaged trustees committed to continuous learning and performance improvement is essential to the board’s effectiveness.
Board members must be responsible for making a contribution and for their own behavior – being on time, coming prepared, asking good questions and engaging in constructive discussions and decision making. It only takes a single director’s dysfunctional behavior to undermine the entire board’s ability to work together and do good work.