Can Healthcare Governance Get to Great? (Yes. Here’s How.)

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By Andrew Chastain, Kimberly Smith, FACHE, and James Gauss

It is easy to spot high-functioning hospital and health system boards. Their trustees are skilled, committed to their organizations, and care about making a real difference in people’s lives.

But excellence in healthcare governance is not something that we see throughout the industry and can be inconsistent from one boardroom to the next, often due to how different boards have been constructed and maintained. You might say that every board is perfectly designed to achieve exactly the results it gets. Boards that demonstrate excellence tend to be “intentional” about improvement and excellence.

Improving board performance is challenging in this era of dramatic reform. It is hard enough for CEOs and top executives to keep up with change much less their trustees who are more removed from daily C-suite discussions and the front lines of patient care.

Today’s boards have spoken and unspoken fears and questions:

  • How can we keep up with change?
  • Do we have the right expertise?
  • How do we manage risk?
  • Is there a new paradigm for investment? For collaboration?
  • We can’t know all the answers.

Other issues that are challenging healthcare governance include:

  • Many boards take a passive stance on board recruitment and developing or obtaining necessary and critical competencies.
  • Boards generally do not encourage turnover and term limits and thus do not bring in new blood on a regular basis.
  • Trustees are reluctant to evolve. Changing board culture and behavior is not easy and can be disruptive.
  • Board chairs can micromanage. They can be too operational with “nose and fingers in” at the expense of a big-picture view and focus on the future.
  • Other legacy structures, practices or behaviors can serve as obstacles in delaying “systemness” and integration.

A Path Forward?

How can boards improve themselves? Can weak boards become good ones and can already good boards get to great?

We think so. This is why we have introduced “Building Better Healthcare Boards,” a 50-page resource of best practices. (Brief registration required.) This guidebook is intended to provide boards with concrete ideas about how to improve governance in rapidly changing times. Boards can be intentional in understanding themselves, educating themselves, bringing in new blood, planning for the future, and engaging more meaningfully with the organization, constituents and industry. Boards can be smarter, more efficient, and more reflective of the times they live in and the people they serve.

Building better healthcare boards can be done, and many boards are already taking the steps that we illustrate in this resource. “Building Better Healthcare Boards” highlights ideas of good governance that are both practical and progressive, in the spirit of improving healthcare as a whole.

Guidebook: Building Better Healthcare Boards

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