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A successful governance education process requires commitment, collaboration and consensus. This resource serves as an outline of how a board of trustees may design a process that will ensure optimum development of leadership knowledge and effectiveness.

To maintain the momentum of continuous governance improvement, many "best practices" boards institute regular mini-evaluations of board meetings. Here, each board meeting concludes with every board member anonymously completing a brief evaluation form of how the board planned for and used its time during the meeting.

Effective decision making often requires different techniques or approaches for different types of decisions. The following techniques and practices can help support and strengthen your board’s decision-making processes.

The road to integration of hospitals and physicians has been a rocky one for many health care organizations. Failed attempts to integrate in the 1990s resulted from the realization that operating physician practices was very different from operating hospitals, leaving many health care providers wary of heading down the same road again.

The organization’s most important stakeholders have been identified/specified. A descriptive/analytic profile has been prepared for each key stakeholder. The interests (needs/wants, expectations and organizational success criteria) of each stakeholder have been documented.

Just as the health industry continues to shift care delivery from a volume- to a value-based model, so too must the health care board evolve beyond its traditional fiduciary and core governance responsibilities to encompass a more strategic and global view. The success of this evolving model depends on shared governance—a stronger alignment and engagement among the board, physician leadership and management.

The Hospital System Board of Trustees Quality Committee shall meet quarterly in order to provide: Visibility and focus for the organization’s commitment to the delivery of high quality medical care; Oversight of quality and performance improvement initiatives across the Hospital System.

Most boards and governance experts say boards should be meaningfully involved in shaping and ultimately approving the strategic plan and major decisions—but if they try to develop plans, they’re bordering on management. The tricky part is distinguishing meaningful involvement from development.

Today’s hospital leaders know their trustees must be more adaptable, connected and knowledgeable about the changing health care landscape than any of their predecessors. But do they believe their volunteer community board is truly capable of stepping up to current field challenges?

High-performing boards across the country have made great strides in enhancing their effectiveness and efficiency.

Here are 10 steps for optimizing the way a board uses its meeting time.

Mergers and acquisitions (M&A) are occurring throughout health care, with transactions happening among entities of all provider types and sizes.(According to the latest analysis by Kaufman, Hall & Associates, LLC, 49 transactions were announced in the first half of 2015, up from 43 transactions in the first half of 2014.)

The highest-performing boards across the country share certain key characteristics that can be grouped into five categories - visionary, nimble, intentional, competency-based and objective.

Securing board approval for a major new project can be a long and tricky process when the CEO proposing it isn’t sure which criteria trustees will use, and the board is equally uncertain what the yardsticks ought to be. At Adirondack Medical Center in Saranac Lake, N.Y., President and CEO Chandler Ralph asked her board to write down and agree on project evaluation criteria. In a two-hour workshop, trustees came up with 14 points that they now apply to every decision about whether to implement a new program.

Even before the Enron scandal, which featured directors who didn’t understand the company’s complex financial transactions, and before the Sarbanes‐Oxley Act required publicly owned corporations to disclose whether their boards include directors with financial expertise, it should have been self‐evident that relevant knowledge and experience are prerequisites for effective governance.  

In 2009 the AHA’s Blue Ribbon Panel on Trustee Core Competencies identified two sets of competencies that focused on the knowledge, skills and personal capabilities needed by trustees of hospitals and health systems to govern effectively.

The trustees of one health system were divided over how to structure the board. Some favored proportional representation from its acute care, nursing home and elder services divisions; others wanted all at-large members with no interests to promote. The CEO of another health system had restructured so facility executives were directly accountable to corporate management for finances and operations. He wanted local boards to focus on strategic direction and oversight of quality, but local boards continued monthly monitoring of finances as they’d always done. Some trustees wondered what their role was.

In industries where safety is critical and quality must come first, such as airlines and nuclear power, “red rules” refer to protocols that must be followed “to the letter” – all work stops until they are. A commercial airliner doesnʼt leave the gate if the pilot spies a possible leak or flat tire; a nuclear plant operator or even a Toyota assembly line worker can “stop the line” when he spots a critical flaw.

The governance challenges raised in the post-Enron environment are motivating many boards and their general counsels to draft new board policies and tighten up existing ones.

Great organizations have great leadership— at the top and throughout their ranks.