According to the Great Boards 2016 Fall Newsletter, half of all Board Chairs have no training or mentoring; nineteen percent learn through board progression experience. Most trustees don’t have any healthcare background and an unspecified number of hospital senior leaders think new trustees without healthcare experience take approximately three years to gain confidence in their ability to collaborate effectively.
Dr. Carla Boutin-Foster and colleagues define the medical culture as “the language [slang], thought process, styles of communication, customs and beliefs,” which is used to describe the informal and highly specialized nomenclature and vocabulary used by the healthcare industry. Trying to understand the hospital’s cultural language becomes one of the primary challenges for Trustees when managing their conversations and coming to consensus on decisions.
In a national study on the perspectives of nonprofit board chairs, Nonprofit Quarterly’s fall 2016 edition explored what preparation was done by board chairs and how they see their relationship to the board and other key stakeholders. What they found was a glaring picture of neglect with 51% of respondents doing nothing to prepare to become board chair.
Previously held board officer or leadership position in same institution, i.e., committee chair, vice chair / chair elect has some promise and limitation in preparing an incumbent for the role of board chair.
The majority of board chair respondents relayed that observing the prior chair and asking the CEO for advice was helpful. Coaches, consultants or outside resources were least likely to be considered.
Boards labeled least effective are “rubber stamped” for management recommendations, which provides basic oversight to ensure compliance; boards labeled standard effectiveness requires some thinking regarding proposed prepackaged management recommendations; the highest board performance label requires a governance leadership model that raises critical questions and requires critical thinking from its membership and reporting CEO.
The board chair leadership phenomena has intrigue to it… in the spirit of governance and organizational effectiveness, especially in rural healthcare, how can half of all board chairs assume their role with no or minimal training?
With healthcare changing very rapidly, accommodating long grace periods for board leadership positions is unacceptable. Rural Healthcare key stakeholders, medical staff providers, patients and communities expect their boards to have the skills and competencies to make timely high-stakes decisions, as well understand the best ways to shape and meet their community needs.
Boards in all sectors are being held to a higher standard of performance and accountability. They are expected to be more actively involved in setting organizational strategy, resource allocation, capital financing, investments, conflict management, executive performance, management and succession planning, clinical quality and external relations. It can be quite overwhelming.
Dennis D. Pointer, governance expert, offers this insight, “Boards are as high up in organizations as one can go and still remain inside them. They bear the ultimate fiduciary responsibility, authority and accountability for their organization’s affairs.” A fiduciary is an individual in whom another has placed the utmost trust and confidence to act for their benefit.
Many board development assessments I have conducted conclude that board members are good citizens who don’t have a clear sense of what their obligations are and what type of work needs to be accomplished. Board members role expectations, as well as, their board chair, committee chairs and their CEO roles have not been collectively discussed, understood or agreed on.
Bruce Stickler, Board Chair at the Illinois Department of Public Health, said that expectations for boards and their chairs have changed dramatically, “Board chairs have to be much more active today in every aspect of healthcare change, including collaborative arrangements and community services. They can’t leave the work to the staff; they must provide leadership and direction and be involved.”
What causes board and board chair failures? It’s a board’s tapped out choice in selecting someone who doesn’t understand what governance means and how to exercise it. In my next post, I will cover how this phenomenon can be corrected.
This article is in response to “The Hard Work of Culture” by John Mitchell CEO from Modern Healthcare Online.
The underlying message of John Mitchell’s article (one of the most requested) is both correct and refreshing. Its content signals to me that a CEO in a leadership mindset needs first to realize the importance of organizational culture and its many subcultures that contribute to the success of an entity. Organizational culture reflects the beliefs and behaviors in which, overtime, a body develops, learns and acts out each day. Its objective is the status quo [survival], and today in many healthcare organizations, survival is the only mindset.
Very few CEOs perceive the importance of their role and that of senior leaders plays in leading and championing desired culture change to ensure its survival and competitiveness. Mr. Mitchell does.
The vast majority of CEOs do not understand how the power of their organizational culture correlates to their legacy or tenure success. Most CEOs focus on pleasing their board chair and feel partially accountable for the behaviors and beliefs demonstrated every day in their organization, about which they cannot change as they focus on the bottom line. I say “partial” accountability for their organization’s culture because full accountability is with the board of directors. I can safely say many board members do not understand this responsibility as one of their primary duties as many have revealed, “I was never told.”
In reality, physician clinical integration and alignment in most cases requires an organization to transform their culture to the new behavior
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.