When it comes to strengthening health care governance, today's environment presents paradoxes and possibilities.
Boards have access to an array of excellent governance resources, advice and benchmarking information, but often have limited time and capacity to effect rapid adoption. Some boards have relied on incremental change over time to achieve gains in governance, and may opt to wait until the next chair or a new group of trustees who can lead the charge is in place.

The changes driving the transition from volume to value call for equally transformational governance. Given the scope and pace of change, some boards are concerned that they may not be able to improve their own practices fast enough to guide their organizations through the challenges ahead.

It's time for boards to focus on significant governance improvement. For many, a steep curve of learning and change will be required to ensure that they keep pace with the journey to high-performance health care under way for their hospitals, health systems and the executives who lead them.

Outside Assistance

Boards that are willing to invest the time and energy to improve and sustain the gains from performance improvement may reach their goals more quickly with the help of outside resources. Just as mentors or coaches have improved the capabilities of developing executives, boards also can benefit from objective guidance from governance experts.

Boards that want to undertake a governance improvement process and are considering engaging outside assistance should keep the following nine guidelines in mind:

  1. The coach should have significant experience in health care organization governance and the ability to benchmark improvements and experiences against boards that are similar to yours. Examining the practices of peer boards can help accelerate adoption of governance improvement.
  2. The coach should understand the dynamics of the board-CEO relationship and be able to diagnose whether the board's relationship with the CEO will support governance improvement.
  3. The coach should be engaged by the board, with full participation in the coaching process by the CEO and, as appropriate, other executives who provide staff support to the board. The best coaching outcomes are achieved when a collaborative relationship exists among all partners in the governance process. A willingness to work and develop together as leaders paves the way for governance breakthroughs that can spark the generative thinking and action necessary to elevate leadership and organizational performance to meet community needs.
  4. The coaching process should allow for examination and catharsis about current and past governance models. Experience shows that boards that resist or skip this step lose the chance to learn from and avoid repeating past mistakes. Failure to address the emotional side of governance improvement more than likely will produce marginal or disappointing results.
  5. The board's governance committee or a specially appointed ad hoc committee should be charged with overseeing the coaching process. The committee's charge should include timely identification of priorities for improvement and establishing aggressive timelines to achieve them.
  6. A good governance coach also should be able to help the board identify stakeholders of the governance improvement process. The board may choose to have these stakeholders provide input to, participate in or be kept informed about the process.
  7. The oversight committee should report regularly to the full board about progress toward achieving governance improvement goals.
  8. Convening a full board retreat to summarize accomplishments, gain acceptance for change and take action is a key step in achieving the buy-in necessary to implement and sustain improvements. Some boards benefit from holding separate retreats to kick off the process and to gain board buy-in.
  9. Charge the board's governance committee with overseeing implementation of improvements, monitoring their effectiveness and periodically reporting on progress to the full board.

Most importantly, boards should use the governance improvement process to engage and unify the board, executives and clinical leaders to accomplish the significant work required to lead transformational change.

Dan Fairley (daniel.fairley@comcast.net) is the owner of Fairley Advisor in Minneapolis.