Today

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.