In the book “Becoming the Change,” Dr. John Toussaint & Kim Barnas, point out that, “The board of trustees is an underused and overlooked resource in just about every hospital and health system we know. Treated like distant, wealthy relatives holding the purse strings while far removed from daily realities...” (pg. 31). Dr. Toussaint’s words ring true for me, as I have seen this firsthand. Boards get sterilized and carefully curated quarterly reports which give little insight into the real needs and performance of the operations. Board members are instead treated like a distant uncle that you only see once a year at a family reunion. It can be a very hands-off impersonal relationship.
In his book, John chronicles his learning at ThedaCare in 2008 when he was focused on selecting the right CEO to succeed him and the detrimental impact of not adequately considering the importance of the board. Boards oversee various functions and members may have a longer tenure than the CEO. This group is critical to sustaining an organization’s continuity of purpose. As I reflected on John and Kim’s book along with my own experiences, it made me think that perhaps one of the core issues around health system performance, may be how boards are engaged. How can a board member really help if they have not been brought in on a deeper level? Healthcare is becoming more complex by the day on nearly every front from payment models, technology, cybersecurity, regulations, staffing shortages, and so on. Has the traditional model of board engagement outlived its usefulness?
According to 2022 Fierce Healthcare report, “Anywhere from 53% to 68% of the nation’s hospitals will end 2022 with their operations in the red versus the 34% reported in 2019.”2 These negative operating trends have persisted into 2023. What would it look like to have board members more engaged?
Five ideas to consider:
1) Have board members learn more through Gemba walks as a part of their onboarding process.
2) Have board members in high profile projects so they can understand the problems and how they are solved.
3) Bring broad members in earlier as problems start to arise.
4) Train board members in the core tenants of continuous improvement.
5) Select members that are deeply curious, patient, humble, and have insatiable appetite for problem-solving.
What if boards had a more in-depth understanding of healthcare complexities? How would that impact the decisions they make, patient care and financial performance? Cleveland Clinic and UMass Memorial Health, are two institutions moving in the right direction. Changing your board engagement strategy is no easy task but may be worth considering.
About the author: Jeff Lewis is an RN consultant 1. Becoming the Change 2. Hospitals' 'unsustainable' 2022 losses forcing service
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