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Jessica Carter had never contemplated running for a hospital board until she was urged by several older and politically active women who were members of the fitness facility where she worked.

“They really gave me the knowledge to move forward,” says Carter, elected in November at age 25 to a board seat at Lee Memorial Health System, Fort Myers, Fla. “They said it was a fresh breath of air to have someone of my generation to step up and be active and involved.”

Carter, a 2009 college graduate who majored in human performance/exercise science, campaigned on improving the system’s commitment to the health of local residents to better keep them out of the hospital. Carter is one of several under-40 members who joined the 10-member board since the 2012 election, says Richard Akin, the board’s chair.

It can take as long as two years to get up to speed on the complexities of hospital governance, but the new additions already show great promise, Akin says. “We definitely need that younger perspective — I don’t think there is much question about it,” he says, adding, “Some of us probably don’t even know what Twitter is.”

When diversity is discussed, the need to enhance racial and gender representation are most frequently highlighted. But trustees miss a strategic opportunity if they don’t think more broadly, says Fred Hobby, chief executive officer of the Institute for Diversity in Health Management, an American Hospital Association affiliate. The modern-day board should incorporate a spectrum of ages, socioeconomic backgrounds and other elements, such as sexual orientation and religious perspectives that best reflect the community served, he says.

If the hospital treats a lot of Jewish patients, that voice should be reflected at the board table, Hobby says. A children’s hospital might consider adding a very young member, perhaps even someone in his or her late teens, he suggests, “to get the benefit of a young person’s thinking about what resonates with children in a pediatric hospital,” he says. “Our boards are not being bold enough to consider things out of the box.”

As a general rule, today’s boards remain disproportionately white haired, according to a survey published in 2011 by the Center for Healthcare Governance. In 2011, 24 percent were age 50 or younger, a slight decrease from 29 percent in 2005. Nine percent of trustees were 71 years or older.

Age, Income Shape Perspectives

While more difficult to track by surveys, recruiting a mix of trustees with a cross-section of socioeconomic backgrounds is an important and often overlooked element of the diversity picture, experts say. In other words: board service shouldn’t be limited to wealthy professionals.

Don’t add the president of a local bank, who happens to be African-American, and assume that his or her views reflects all of that minority community’s experiences, Hobby says. That bank president meets “the racial test,” Hobby notes. “But are they culturally aware of the differences that exist within these groups of minorities?

“The president of the bank probably doesn’t have a clue about a female head of household who also is of color, who is unemployed and has five children and is just about to get insurance under the Affordable Care Act,” he says. “They are miles apart.”

To keep the door open to a variety of board candidates, Cleveland-based University Hospitals hasn’t instituted a minimum amount that each member must donate to the system, only requiring that all participate, says Janet Miller, chief legal officer for the nonprofit hospital system. “We expect 100 percent giving,” Miller says. “We don’t expect everybody to be able to give million dollar gifts.”

It’s a long-standing policy, one that has been discussed at various points by the board’s governance committee, but not changed, she says. “Because they feel strongly that they want to be able to have people of different economic levels to serve on the board.”

Another long-standing policy: members must not be older than 72 years old. In recent years, the system has worked to add younger board members, Miller says. The hospital business has never been more complex, and it’s important to start cultivating future governance leaders, she notes.

Younger trustees may not have yet accrued significant wealth, Miller says, “but you want to get them into that spirit of volunteering and philanthropy. A lot of people are willing to give time, even if they can’t give money right now.”

Establishing term limits also guards against an aging board, says Lawrence Prybil, a professor at the University of Kentucky and principal investigator of a recent study that surveyed governance aspects of 14 of the nation’s 15 largest nonprofit health care systems.

The study, published in 2012 by the nonprofit Commonwealth Center for Governance Studies, found that 11 of the 14 systems had adopted some type of term limit. One common approach is to limit terms to three years, stipulating that no more than three consecutive terms be served.

“When you don’t have term limits, and you don’t have limits on the number of terms,” Prybil says, “then it’s easy for people to stay around for a long, long, long time.”

Balancing Needs

Chris Dadlez, chief executive officer of Hartford, Conn.-based Saint Francis Hospital and Medical Center, agreed that younger voices are vital to governance, but believes other priorities must be balanced as well. “To get the perspective of the younger generation is good,” he says. “But if you get too many, a lot of them don’t have as much experience around the skill sets that are really needed.”

James E. Orlikoff, a Chicago-based health care governance expert, has worked with boards that became so grey haired that they literally lost their institutional memory when aged members left in rapid succession.

Yet board candidates in their 30s and 40s can be challenging to court, he notes. “These are people who are raising families, who are trying to establish themselves professionally and whose time is in much greater demand.”

Shouldering the work load — that’s one benchmark that all board candidates must meet, no matter their background, Prybil says.

“That to me is transcendent,” he says. “When we’re talking about commitment and dedication and willingness to devote time and energy, we don’t want diversity there.”

For more on building a more diverse board, read our cover story, “Diversify Your Board.”

Charlotte Huff is a health and business writer based in Fort Worth, Texas.